Original Articles

Prevalence of Rare and Common Bleeding Disorders in Kurdistan Province of Iran

Akbar Dorgalaleh, Jamal Rashid Panah, Bijan Varmaghani, Peyman Beigi, Abbas Ahmadi

Journal of Cellular & Molecular Anesthesia, Vol. 4 No. 4 (2019), 24 March 2020 , Page 107-111

Background: Congenital bleeding disorders (CBD) are a group of coagulopathies with different clinical and laboratory features. The prevalence of these disorders in different parts of the world is variable. Iran as a country with a high rate of parental consanguinity has a high rate of CBDs. This study was to report the prevalence of these disorders in Kurdistan province, west of Iran.

Methods and materials: This descriptive study was conducted on patients suspected of a congenital bleeding disorder referred to hemophilia center of this province for evaluation of underlying bleeding diathesis. Diagnosis and classification of disorders were made by routine and specific laboratory tests.

Results: Out of 107 patients, 65.4% affected by common bleeding disorders (hemophilia A and B), 23.4% affected by rare bleeding disorders (RBDs) and 11.2% had inherited platelet disorders. Factor VII deficiency (64%) was the most common RBDs and 9 patients had von Willebrand disease. Out of three patients with inherited platelet disorders, two had Glanzmann thrombasthenia.

Conclusion: CBD pattern though has similar patterns with total pattern of the country, some of the inherited platelet disorders are more common in Kurdish province. Determination of prevalence and distribution of these disorders can improve health system planning and resource allocation.

Keywords: Congenital bleeding disorders, Rare bleeding disorders, Common bleeding disorders, inherited platelet disorders

Comparison of Tracheal Extubation Comfort between Two Endotracheal Tube Filling in Laparoscopic Cholecystectomy

Siamak Yaghoubi, Nilofar Massoudi, Hamid Kayalha, Karen Samimi

Journal of Cellular & Molecular Anesthesia, Vol. 4 No. 4 (2019), 24 March 2020 , Page 112-120

Background: Post-intubation airway complications such as cough and sore throat are common complaints after anesthesia. After intubation, filling the endotracheal tube will close the tube space and stimulate the endotracheal tube. It is used to fill the cuff with air or liquids such as normal saline, lidocaine, etc. The purpose of this study was to compare the comfort of tracheal extubation between the two methods of filling the tracheal cuff with lidocaine 2% and filling with air in patients undergoing laparoscopic cholecystectomy.Methods and materials: In this single-blind clinical trial study, 70 patients were randomly divided into two groups of air and lidocaine. In the lidocaine group, the endotracheal tube cuff was filled with 2% lidocaine and in the air cuff group the cuff pressure reached 20 to 25 cm of water. Blood pressure and heart rate of patients before induction, after induction, 30 and 60 minutes after and before and after extubation, as well as complications of intubation including bucking, cough and sore throat during recovery, 6 hours and 12 hours later were compared. Data were analyzed using SPSS software version 16.Results: The results of this study showed that there were no significant differences in heart rate at different intervals of the study including pre-induction, post-induction, 30 and 60 min, before and after extubation. But the systolic and diastolic blood pressure after extubation were significantly lower in the lidocaine group than in the air group, although at other intervals there was a significant difference between the two parameters in the study groups. After extubation, sore throat complications were significantly lower at all study intervals.Conclusion: According to the results of the same study, it seems that filling the cuff with lidocaine over the air leads to more hemodynamic stability and less side effects after extubation.

Keywords: Intubation, Lidocaine, Complications

Intravenous Drug Sedation for MRI in Children; A Randomized Controlled Trial

Mehrdad Mesbah Kiaei, Arash Jafarieh, Abolghasem Yoosefi

Journal of Cellular & Molecular Anesthesia, Vol. 4 No. 4 (2019), 24 March 2020 , Page 121-127

Introduction; Performing MRI in children is a matter of concern and needs adequate sedation because patients should be completely motionless to provide a good quality of imaging.  The aim of this study was to compare the effects of Nesdonal and Propofol + Lidocaine to provide sedation in children undergoing brain MRI.

Methods; This was a randomized, blinded trial including 250 patients aged 3 months to 13 years who were candidate for elective brain MRI. Participants were divided into two groups. Group 1 received Nesdonal and group 2 received Propofol + Lidocaine. Demographic characteristics were recorded. Unconsciousness time, scan time and discharge time were compared between the two groups. Data was analyzed using SPSS version 16 by Chi-square, ANOVA, Man-Whitney and T-test (p value < 0.05).

Results; Totally 250 patients were assigned randomly to two groups of Propofol + Lidocaine and Nesdonal, each including 125 patients. There was no meaningful difference regarding demographic factors of age, gender or ASA class between the two groups. There was no meaningful statistically difference regarding unconsciousness time (P value=0.655), scan time (P value=0.324) and discharge time (P value=0.436) between the Propofol + Lidocaine and Nesdonal group. Some minor adverse effects occurred in the Propofol + Lidocaine group. No major complication occurred.

Discussion; Nesdonal was superior to Propofol + Lidocaine regarding lower adverse effects, lower costs, no need for an infusion pump and not lowering seizure threshold.it can be considered safe for sedation in children undergoing brain MRI, especially those with a history of seizure.

Epidural catheter compared with local infiltration analgesia for postoperative pain relief in total knee replacement

Mohammadreza Minator Sajjadi, Mohammadreza Moshari, Mohammad Ali Okhovatpour, Reza Zandi, Keyvan Jalali

Journal of Cellular & Molecular Anesthesia, Vol. 4 No. 4 (2019), 24 March 2020 , Page 128-135


Background: This study compares the effects of epidural analgesia with infiltration analgesia in postoperative pain control for total knee arthroplasty.

Materials and methods: 47 females and 13 males with an average age of 65.7 years were randomly allocated into epidural (EA; n=30) and local infiltration anesthesia (LIA; n=30) groups. All patients received spinal anesthesia and were inserted epidural catheter. In LIA group, 50mL of a mixture, containing bupivacaine, ketorolac, morphine sulfate, and epinephrine was injected in to periarticular tissue and in EA group normal saline was injected. In the EA group, after surgery, an epidural catheter was attached to the patient-controlled analgesia (PCA) infusion pump with 25cc bupivacaine diluted in 75mL of normal saline but in LIA group, the PCA pump of the epidural catheter contained 100cc of normal saline, and the pump was blocked.

Results: The difference in demographic data was not significant between the groups. The mean VAS score (Pain) of EA group was significantly higher than LIA group until 12 hours after surgery, At 24 hours, there was no significant difference between two groups, and Pain of EA group was significantly lower than LIA group at 48 hours after the surgery. Dranage volume and hemoglobin drops were lower in LIA group. Knee range of motion in the LIA group was not superior to that of the EA group two weeks after surgery. The patients’ ability to perform active straight leg raise had no significant difference between two groups one day after the surgery.

Conclusion: local infiltration analgesia is better than epidural for postoperative pain control at first 12 hours. However, epidural analgesia can control postoperative pain more effectively at 48 hours after surgery. There was no significantly difference between two groups regard to patients ability to perform straight leg rising and Knee range of motion was similar in two groups.


Erythropoietin in the clinical trials of the cardiac disease, what is and what is not

Mohamad Masoud Majidi Tehrani, Mahnoosh Foroughi

Journal of Cellular & Molecular Anesthesia, Vol. 4 No. 4 (2019), 24 March 2020 , Page 136-144

Erythropoietin (Epo) is the main erythropoiesis hormone, activate the progenitor red blood cells through proliferation, differentiation and maturation of red blood cells. However, it's another receptor in other tissues, including heart and endothelium, confirm its pluripotent activities. A numerous preclinical studies have shown Epo would be cardioprotective against ischemic events, reperfusion injury and apoptosis. The results of Epo in clinical studies were inconclusive with even associated increased risk of adverse outcomes. In this article, a comprehensive review of the Epo effects is evaluated in the coronary artery disease, cardiac surgery, heart failure and its safety through the results of the most recent clinical trials related to Epo in the cardiovascular disease. The analysis of the available clinical trials demonstrates the most determining factors; Epo dose and administration time related to myocardial ischemia onset. It seems the low dose Epo treatment has tissue protective effect through its receptors, while the higher doses of Epo stimulates the other Epo receptors responsible for erythropoiesis. The safety of high dose Epo therapy to increase risk of thrombotic complications has been controversial. The erythropoiesis-stimulating agents have been proven to successfully correct hemoglobin levels, reduce the need to blood products after surgery and can improve the clinical outcomes, without an increased thromboembolic risk.

Case Report

Anesthetic considerations of Palmoplantar Keratoderma (PPK), a case report.

Parisa Sezari, Masoud Nashibi, Farhad Safari, Ahmad Naderi, Kamran Mottaghi

Journal of Cellular & Molecular Anesthesia, Vol. 4 No. 4 (2019), 24 March 2020 , Page 145-147

Palmoplantar keratoderma(PPK) refers to a group of heterogeneous disorders defined by thickening of skin on the palms and soles. Due to diversity of symptoms and involved organs, the term PPK does not describe each individual patient precisely. The syndrome is quite rare and unknown to the anesthesiologists, while serious associations such as difficult airway or cardiac disease are significant challenges during perioperative management. The literature lacks enough data on anesthetic considerations in these patients, implicating case reports as the only available sources. We revised the accessible information through description of our patient.

Acute and critical care for rabies bitten patients and the different outcomes in a Family: A Post Exposure Prophylaxis (PEP) Failure report

Sara Nouri Basirat, Rouzbeh Bashar, Behzad Pourhossein, Nasim Niknam, Mojtaba Sanji Rafsanjani, Mohammad Reza Shirzadi, Farzaneh Sheikholeslami, Reza Farzad, Maryam Fazeli

Journal of Cellular & Molecular Anesthesia, Vol. 4 No. 4 (2019), 24 March 2020 , Page 148-151

Rabies is a zoonotic viral disease that spread via infected animal saliva. Rabies virus belongs to Lyssavirus genus (Rhabdoviridae family) and the disease is endemic in Iran. The disease causes a fatal encephalomyelitis by infecting the nervous system. Dogs are the most common source of human rabies cases. In this presentation, we had a 58-year-old man who had a dog bitten history on his face and hands with his other two family members with the same dog at the same time. They received post-exposure prophylaxis (PEP) as soon as possible (from day 0). Eighteen days after bitten the man hospitalized and died of rabies three days after hospitalization. Other two relatives were healthy without any rabies symptom. The man was an Iranian veteran with residual body insults during the attacks of chemical warfare from the combat front. Obtained data in this study suggested that the direct inoculation of the virus to the nerve and immune system inability in virus clearing system were possible etiologies of PEP failure in the reported case.
Keywords: Rabies Virus, Immunoglobulin, Pre-Exposure Prophylaxis (PrEP), Immunosuppression