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Flexible bronchoscopy is employed to diagnose a range of respiratory disorders. Local airway anesthesia is mandatory to facilitate tracheal intubation. It is commonly done by injection of diluted lidocaine through working channel of bronchoscope via Spray-as-you-go (SAYGO) method. Other methods such as airway nerve block (ANB) by direct injection of lidocaine are also used to increase patient comfort. The aim of this study was to compare patient and physician satisfaction during bronchoscopy in two groups receiving SAGO alone versus combination of SAYGO and ANB. In a double-blinded randomized clinical trial, 68 patients undergoing bronchoscopy were divided into two groups. The first group received local anesthesia solely through the SAYGO method, while the second group received a combination of SAYGO and ANB. Both groups received intravenous sedation. The anesthesia level was assessed using Ramsay score. Patient and physician satisfaction with bronchoscopy was evaluated on a numeric scale of 1 to 5. Combination of ANB and SAYGO resulted in significantly higher satisfaction score both in physician [3.4±1.6 and 4.6±0.8] and patients [3.5±1.3 and 4.9±0.4] (P

Background. Pain control after operations is essential in decreasing the patient recovery period and potential morbidity. Prescribing opiates is very effective, but significant side effects accompany them. This study aims to examine the effect of local ketamine infiltration in decreasing pain intensity in patients undergoing transabdominal hysterectomy. Methods. In this double-blind, randomized, controlled clinical trial, a total of 92 patients undergoing transabdominal hysterectomy aged 30–60 years were selected and divided into two intervention and control groups randomly. For the intervention group, ketamine was injected subcutaneously into the incision site at a dose of 0.5 mg/kg after the operation. In the control group, 5 mg normal saline was used in the same method. Postoperative pain intensity was measured using the visual analog scale (VAS: 0–10). The pain score and dose of administered opioids were documented at 1, 2, 4, 6, 12, and 24 hours and compared between the two groups. Results. Postoperative pain intensity was significantly lower in the intervention group than in the control group, except for hour 24. The mean amounts of administered opioids were significantly lower in the intervention group at hours 6 and 12, as well as the total amount of used opioids, and no significant side effects were documented. Conclusion. Local ketamine subcutaneous injection in the incisional site is effective and is a safe procedure for reducing pain scores in patients who underwent a transabdominal hysterectomy.

Background: Establishing and maintaining a secure airway using a cuffed endotracheal tube (ETT) is an important step in management of intubated patients. Out-of-range ETT cuff pressure is associated with various complications which could lengthen the hospital stay. The aim of this cross-sectional study was to evaluate ETT cuff pressure in intubated patients in the emergency department (ED), operating rooms (ORs), and Intensive Care Units (ICUs) of Imam Khomeini Hospital Complex (IKHC), Tehran, Iran. Methods: The ETT cuff pressure of 153 patients was measured using a standard manometer. Demographic data and duration of intubation were recorded. The data were analysed using the SPSS software version 16. P values less than 0.05 were considered significant. Results: The ETT cuff pressure exceeded the recommended range in 125 out of 153 patients (81.7%). The mean cuff pressure (67.29 cmH2O) was significantly higher than the recommended range (p

Background: The aim of this study was to assess the quality of the surgical field, amount of blood loss, and duration of surgery following induced hypotension with labetalol, nitroglycerin, and high dose propofol in patients undergoing FESS under general anesthesia. Methods: One hundred and eight patients scheduled for FESS under general anesthesia were recruited in this randomized trial and were allocated to one of the three study groups: 1) Nitroglycerine (NTG) group: nitroglycerine with a dose of 2-5 μg/kg/min was administered; 2) Labetalol (LAB) group: an IV bolus dose of labetalol (20 mg) was injected at first and then IV infusion of labetalol at a rate of 1-2 mg/min; 3) High dose propofol plus normal saline (0.5-1 ml/min) group. Hemodynamic variables and the amount of bleeding were recorded intraoperatively and the surgeons' satisfaction was asked following each surgery considering the surgical field quality using a 5-item Likert scale. Results: The average blood loss (ml) in patients in the LAB group was significantly less than patients in NTG and high dose propofol groups (127 ml vs 198 and 145 ml, respectively) (p- value=0.001) and the surgeons expressed greater satisfaction with the surgical field quality in the LAB group (p- value=0.001). Conclusion: Labetalol infusion may be a safe and effective method for induction of controlled hypotension to provide a comparatively bloodless field. High dose propofol may be a second choice if labetalol is not available.

Background: Patients undergoing surgery experience significant anxiety in the preoperative period. The aim of the present study was to identify the level of preoperative anxiety among Iranian patients in surgery clinics and its predictive factors. Methods: In this cross-sectional study, the State-Trait Anxiety Inventory questionnaire was used to assess the patients’ preoperative anxiety. Results were analysed using the Chi-square test and binary logistic regression analysis. Results: 246 patients were randomly selected, 222 of which were finally included in our analysis. In this study, the state and trait anxiety levels were moderate and low, respectively. Both state and trait anxiety levels were significantly higher among females (p-value 0.03 and 0.009, respectively). Also, patients with higher education had higher state and trait anxiety levels (p-value 0.001 and

Background: Upper GI endoscopy is a diagnostic and therapeutic procedure widely used across the world. Some patients, however, experience a great deal of discomfort during the procedure, which is mainly due to activation of the gag reflex. Therefore, topical pharyngeal or general anesthesia is applied to reduce the gag reflex during endoscopy. This study aimed to compare the effect of IV lidocaine versus topical lidocaine spray in reducing the gag reflex in patients sedated with propofol. Methods: This randomized clinical trial was conducted in Imam Khomeini Hospital in 2017. One group of patients received propofol at a dose of 0.5-1 mg/kg plus lidocaine spray and the other group received propofol at the same dose plus IV lidocaine at a dose of 1 mg/kg (maximum 100 mg). Patients in both groups also received 50 µg fentanyl. The variables of gag reflex (using the VAS), patient and physician satisfaction, length of endoscopy, vital signs, and adverse effects were compared between the two groups. Results: Ninety-three patients were evaluated in this study, of whom 42 (45.2%) were men and the rest were women (n=51, 54.8%). ANOVA was used to evaluate the effect of type of anesthesia on the final level of gag reflex and the results showed lack of any significant difference between the two groups (P>0.05). Patient satisfaction was higher in the IV anesthesia group (P= 0.036) and the physician satisfaction was higher in the topical anesthesia group (P= 0.027). Among vital signs, only SBP showed a modest difference between the two groups and was significantly higher in the topical anesthesia group (P=0.04). There was no significant difference in the rate of adverse effects between the two groups (P> 0.05). Conclusion: Topical anesthesia using lidocaine spray is as effective and safe as IV lidocaine in decreasing the gag reflex in upper GI endoscopy in patients sedated with propofol.

Background: Despite the growing advancements of surgical and anesthetic techniques resulting in decreased morbidity and mortality, the period before surgery remains stressful for most patients. Considering the adverse effect of preoperative anxiety on anesthesia and surgery outcomes, we conducted this study to evaluate the level of anxiety in the anesthesia clinic among Iranian patients undergoing surgery and also to determine its associated factors. Methods: This was a cross-sectional study performed on 231 patients admitted to the anesthesia clinic of Imam Khomeini hospital, Tehran, Iran. Data were collected by using a three-part questionnaire consisting of demographic data, clinical findings and the translated version of Spielberger state-trait anxiety inventory (STAI). Chi-square test and binary logistic regression model were performed for univariate and multivariate analysis, respectively. A p-value< 0.05 was considered statistically significant. Results: The mean (SD) score for state and trait anxiety were 39.8 (13.4) and 36.5 (12.2), respectively. A significant association was seen between state anxiety and age, gender, occupation, level of education, marital status, patients’ awareness of type of anesthesia and patients’ awareness of anesthesia adverse events (p< 0.05). The most predictive factors for state anxiety were age, patients’ awareness of anesthesia adverse events and female gender, and for trait anxiety these factors were age, place of residence and female gender. Conclusion: Screening for anxiety and identifying individuals vulnerable to preoperative anxiety (e.g. younger patients, females…) can help reduce undesirable surgery outcomes and their economic burden on the healthcare system.

This research is a method review type, comparative study between the effects of General anesthesia versus those of spinal anesthesia during caesarean section on the newborns and the mother undergoing cesarean section. The variables considered in the study included patient family history, patient medical history, status of patient during pregnancy, age of patient, and emergency or planned cesarean. Both general and spinal methods of anesthesia had differing results in multiple aspects and effects both during and after the surgery. However, pros of spinal anesthesia topped those of general anesthesia and is therefore the more favorable method of anesthesia

Background: Low Back Pain (LBP) is a common musculoskeletal disorder which may have an occupational or non-occupational etiology and is seen in many health care providers. It is an important cause of morbidity and workplace absence. Various factors may result in LBP but the role of occupational stress and anxiety personality disorder is still unclear. Methods: Face-to-face interviews were conducted with 58 anesthesiologists working in the hospitals of Tehran University of Medical Sciences to evaluate the occurrence of LBP in the first year of work. The probable causes of LBP and the level of anxiety were assessed using a questionnaire designed for this purpose, based on Spielberger state-trait anxiety inventory (STAI), and the results were analyzed. Results: Of 58 participants, 44 (75.9%) were men and 14 (24.1%) were women. The mean age of the participants was 45.6±6.3 years. Twenty-four of 58 participants (41.4%) reported LBP in the first year of work. Six participants (10.3%) did not have anxiety state but had LBP in the first year of work. Eighteen subjects (31%) with mild to severe anxiety state also had LBP in the first year of work. Nine anesthesiologists (15.5%) did not have anxiety trait but had LBP in the first year of work. Fifteen participants (25.8%) had mild to severe anxiety trait and had LBP in the first year of work. In general, 24 of 58 participants (41.4%) with an anxiety score of 47.52 (moderate level of anxiety) had LBP, and 34 of 58 participants with an anxiety score of 41.01 (moderate level of anxiety) did not have LBP. There was a significant correlation between the occurrence of LBP and the level of anxiety (P=0.014). The personality type, smoking, history of psychiatric disorders, occupational satisfaction, communication with colleagues, sleep quality, history of LBP during work years, especially in the first year, duration of LBP, stress in the first year of work, and weekly hours of exercise had a significant association with anxiety (P

The administration of opioids during induction of general anesthesia is a matter of challenge in obstetric anesthesia. The aim of this study was to investigate the effects of intravenous fentanyl before induction of general anesthesia on the"1st and 5th minutes' Apgar scores" in neonates with elective cesarean surgery. In a double blinded randomized clinical trial on 60 parturients undergoing elective cesarean surgeries under general anesthesia in Vali-e-Asr Hospital, in Tehran, Iran, were divided randomly into two groups; the intervention group and the control. In intervention group, intravenous fentanyl 1µg/kg was administrated three minutes before anesthesia induction. The induction route, laryngoscopy and tracheal intubation were the same in the groups. The blood pressure (BP) and heart rate (HR) measures were recorded before anesthesia induction (as baseline measures) and so during laryngoscopy and intubation. The 1st and 5th minute's apgar scores and the pH of umbilical cord arterial and venous samples were compared in two groups. The systolic and diastolic blood pressure, mean arterial pressure and heart rate changes before and after induction and in various times after intubation showed significant difference between two groups (P0.05). Based on the results of this study, the administration of 1 µg/Kg intravenous Fentanyl, three minutes before induction of anesthesia for cesarean section can lead to a stable hemodynamic situation in mother and showed no effects on neonate`s outcomes. Fentanyl showed no effects on Apgar scores and on umbilical cord arterial and venous blood gases analysis and it probably can be used safely in elective cesarean surgeries. More studies are required to obtain a clear view.

Background: Deliberate hypotension is a strategy that reduces intraoperative bleeding and increases the speed of surgery in otolaryngology procedures. Magnesium (Mg) sulfate is a vasodilator agent that reduces intraoperative hypnotic requirements and in combination with analgesic agents, it reduces intraoperative and postoperative pain. In this study we evaluated the use of intravenous Mg sulfate for inducing deliberate hypotension in rhinoplasty. Methods: Sixty ASA I, II patients aged between 18 to 45, scheduled for rhinoplasty were recruited into a randomized clinical trial. Patients were randomly assigned into placebo (group P) and Mg sulfate (group M) groups. For patients in group M, 40m/kg Mg sulfate was administered before induction and continued with 15mg/kg/hr infusion during the operation. Patients of group P received normal saline as placebo. In each group mean arterial pressure (MAP), mean heart rate, amount of bleeding, anesthetic agents, opioid requirement and duration of surgery were recorded. The incidence of nausea, vomiting, shivering and the score of pain were recorded in post-operative period in both groups. Results: Patients in group M had lower MAP (P= 0.0001), less intraoperative bleeding (P=0.0001), lower anesthetic agents (P=0.0001) and opioid consumption (P=0.001), and shorter duration of procedure (P=0.0001). Mean heart rate was lower in group P (P=0.001). Moreover, surgeon`s satisfaction was more in group P (P=0.001).They also had less incidence of post-operative nausea and vomiting (P=0.008), shivering (P=0.001) and lower pain scores postoperatively (P=0.0001). Conclusion: Magnesium sulfate can be a useful drug to induce controlled hypotension in rhinoplasty surgery. By employing this agent patients have better anesthetic condition and recovery profile.

The administration of opioids during induction of general anesthesia is a matter of challenge in obstetric anesthesia. The aim of this study was to investigate the effects of intravenous fentanyl before induction of general anesthesia on the"1st and 5th minutes' Apgar scores" in neonates with elective cesarean surgery. In a double blinded randomized clinical trial on 60 parturients undergoing elective cesarean surgeries under general anesthesia in Vali-e-Asr Hospital, in Tehran, Iran, were divided randomly into two groups; the intervention group and the control. In intervention group, intravenous fentanyl 1µg/kg was administrated three minutes before anesthesia induction. The induction route, laryngoscopy and tracheal intubation were the same in the groups. The blood pressure (BP) and heart rate (HR) measures were recorded before anesthesia induction (as baseline measures) and so during laryngoscopy and intubation. The 1st and 5th minute's apgar scores and the pH of umbilical cord arterial and venous samples were compared in two groups. The systolic and diastolic blood pressure, mean arterial pressure and heart rate changes before and after induction and in various times after intubation showed significant difference between two groups (P0.05). Based on the results of this study, the administration of 1 µg/Kg intravenous Fentanyl, three minutes before induction of anesthesia for cesarean section can lead to a stable hemodynamic situation in mother and showed no effects on neonate`s outcomes. Fentanyl showed no effects on Apgar scores and on umbilical cord arterial and venous blood gases analysis and it probably can be used safely in elective cesarean surgeries. More studies are required to obtain a clear view.

The study seeks to unravel the intricate operational sequence involved in preparing prehistoric pigments for rock art within the Puerto Roque rock art shelter. Sixteen pigment samples were meticulously collected from specific figurative representations. Additionally, three ochre samples were sourced from the shelter’s soil. Employing a comprehensive multi-analytical approach, including Raman microspectroscopy, X-ray microfluorescence (EDxrf), Fourier-transform infrared spectroscopy (ATR-FTIR), and scanning electron microscopy (SEM-EDS), all nineteen samples underwent thorough analysis. Notably, darker pigments revealed a composition of hematite with the added presence of carbon. Meanwhile, one sample exhibited an orange hue primarily composed of goethite and bright red pigments predominantly characterised by hematite, as confirmed by Raman analysis. EDxrf analysis demonstrated an elemental composition akin to the three ochre pieces examined. Furthermore, ATR-FTIR spectroscopy suggested the potential influence of a heating process in enhancing red coloration, corroborated by spectral results from specific samples. This finding aligns with prior research, underscoring the technological sophistication embedded in early artistic endeavours.

Ancient Ardaxšīr Khwarrah, today known as Shahr-e Gur, situated near the modern town of Firuzabad in Fars, Iran, holds historical significance as the inaugural capital city of the Sasanian Empire. During archaeological excavations conducted in 2005 by an Iranian–German team directed by Mas‘oud Azarnoush and Dietrich Huff, a mud-brick complex was uncovered, revealing a remarkably well-preserved stretch of wall painting and a polychrome painted floor. The discovery prompted the hypothesis of a potential funerary context dating back to the Sasanian period. Both the wall painting and painted floor have suffered extensive deterioration attributed to the environmental conditions of the archaeological site, which was inscribed on the UNESCO World Heritage List in 2020. To address the urgent need for preservation and further understanding of the site’s artistic and structural elements, an emergency diagnostic project was initiated. Non-invasive investigations were carried out on the wall and floor by optical digital microscopy and portable energy-dispersive X-ray fluorescence. Additionally, representative minute samples underwent analysis through various techniques, including micro-X-ray fluorescence, polarised light microscopy, scanning electron microscopy with energy-dispersive X-ray spectroscopy, micro-Raman spectroscopy, micro-Fourier Transform Infrared Spectroscopy, gas chromatography-mass spectrometry and pyrolysis coupled with gas chromatography-mass spectrometry. The palette of the floor and mural paintings were identified to contain red and yellow ochres, lead-based pigments, carbon black and bone white. The unexpected presence of Egyptian blue mixed with green earth was recognised in the green hues of the wall painting. The detection of protein material in both the wall painting and polychrome floor indicates the use of “a secco” technique, thereby shedding light on the artistic practices employed in Ardaxšīr Khwarrah.

This work is focused on the characterization of metallic finds that are part of an ancient war biga from the Tomba della Biga, using different approaches for the diagnostics and also the conservation of this important cultural heritage. The materials analyzed were brought to light in the necropolis of Canal Bianco (Adria, Italy). The samples were analyzed using Optical Reflected Light Microscopy (ORLM), Scanning Electron Microscopy (SEM) and micro-Raman Spectroscopy (µ-RS). The results highlighted the occurrence of two different alloys (Fe and Cu-Sn-bronze) showing important structural and textural variations. These results, along with µ-RS, gave details on the surface and subsurface morphology, as well as the microstructures and the chemical and mineralogical composition of the finds. In particular, µ-RS highlighted the presence of magnetite and goethite as the main mineralogical phases for Fe-samples and malachite, azurite and Cu-oxide for bronze samples. In addition, an attempt was made to trace the manufacturing process, the purity of the alloys and the degree of slagging. Results of analytical studies show corrosion products of the samples which could be evidence of metallurgical aspects. The good state of conservation due to favorable conditions in the burial environment preserved the metal finds from intense corrosion, supporting the hypothesis that the samples reached equilibrium with soil during their life in the burial environment. This proposed methodology based on the microstructure, chemistry and mineral microanalysis allows the diagnostic and evaluation of the state of conservation of metallic finds.

Pagán is an ancient city located in Myanmar that is renowned for the remains of about 4000 pagodas, stupas, temples and monasteries dating from the 11th to 13th centuries. Due to a magnitude 6.8 earthquake in 2016, more than 300 ancient buildings were seriously damaged. As a part of the post-earthquake emergency program, a diagnostic pilot project was carried out on Me-taw-ya temple wall paintings to acquire further information on the materials and on their state of conservation. This article presents our attempts at characterising the painting materials at Me-taw-ya temple using non-invasive portable energy dispersive X-ray fluorescence (ED-XRF), portable Raman spectroscopy and micro-invasive attenuated total reflectance—Fourier transform infrared spectroscopy (ATR-FTIR), micro-Raman spectroscopy (µ-Raman), gas chromatography-mass spectrometry (GC-MS), polarized light microscopy (PLM) and environmental scanning electron microscope—X-ray energy dispersive system (ESEM-EDS) investigations with the aim of identifying the composition of organic binders and pigments. The presence of a proteinaceous glue mixed with the lime-based plaster was ascertained and identified by GC-MS. In addition, this technique confirmed the occurrence of plant-derived gums as binders pointing to the a secco technique. Fe-based compounds, vermillion, carbon black and As-compounds were identified to have been incorporated in the palette of the murals.