Houman Teymourian - Academia.edu (original) (raw)

Papers by Houman Teymourian

Journal of Iranian medical council, Mar 3, 2024

The Internet Journal of Anesthesiology, 2007

Introduction: Evaluation of the depth of anesthesia is especially important in good and useful ha... more Introduction: Evaluation of the depth of anesthesia is especially important in good and useful handling of the patient. Clinical assessment of EEG in the operating room is one of the major difficulties in this field. This study tries to find the most valuable EEG parameters in prediction the depth of anesthesia in different stages. Material and methods: EEG data of 30 patients with same anesthesia protocol (total intravenous anesthesia) were recorded in all anesthetic stages at the SHOHADA-E-TAJRISH hospital. Quantitative EEG characteristics were classified into 4 categories: time, frequency, bispectral and entropy based characteristics. Their sensitivity, specificity and accuracy in determination of depth of anesthesia were obtained by comparison with the recorded reference signals in awake, light anesthesia, deep anesthesia and brain death patients. Result: Time parameters had low accuracy in prediction of the depth of anesthesia determination. The accuracy was 75% for burst suppression response. It was higher for frequency based characteristics which the best results were in β spectral power. (Accuracy: 88.9%) The accuracy was 89.9% for synchronized fast slow bispectral characteristics. The best results were obtained from entropy based characteristics which its accuracy was 99.8%. Conclusion: Entropy based characteristics analysis have a great value in predicting the depth of anesthesia. Generally, due to the low accuracy of each single parameter in prediction depth of anesthesia, we advise multiple characteristics analysis with more persistence on entropy based characteristic.

Anesthesiology and Pain Medicine, Feb 21, 2018

Background: In patients admitted to the Intensive Care Unit (ICU), Enteral Nutrition (EN) is the ... more Background: In patients admitted to the Intensive Care Unit (ICU), Enteral Nutrition (EN) is the first choice for feeding support, however, it is often complicated by gastrointestinal side effects, such as diarrhea. There are no studies that have specifically evaluated effect of a prebiotic, which prevents diarrhea during enteral nutrition. Objective: This study aimed at evaluating the effect of honey in enteral diet during occurrence of diarrhea and fecal microbiotain in critically ill patients. Materials and Methods: In this double-blind, randomized controlled single-center study, 32 patients were randomly selected to receive a high protein kitchen enteral diet and the study group had honey as 10% of its carbohydrate intake. Quantitative analyses of bifidobacterium and Lactobacillus species of fecal samples were assessed by Real-Time Polymerase Chain Reaction (PCR) on days 0 and 7. Results: Patients in the honey group showed an insignificant increase in the frequency of bifidobacterium DNA by study day 7 in comparison with the control group. In the honey group, there was a considerable reduction in diarrhea (P = 0.09). A significant difference was found in length of Intensive Care Unit (ICU) stay (P = 0.001) and Sequential Organ Failure Assessment (SOFA) score (P = 0.04) in favor of the honey group. Conclusions: Enteral nutrition with honey might reduce the length of stay at the ICU and development of organ failure in critically ill patients. It seems that honey helps reduce the incidence of diarrhea.

Nephro-urology monthly, May 17, 2023

Background: Evidence shows that spinal anesthesia can alter the penile length and penile engorgem... more Background: Evidence shows that spinal anesthesia can alter the penile length and penile engorgement and the fact that patients undergoing spinal anesthesia may experience erectile dysfunction. We hypothesized that spinal anesthesia would not result in altered penile length; however, it can lead to temporary erectile dysfunction. Methods: A total of 73 patients referred to our hospital for endoscopic urological surgeries underwent either spinal anesthesia (SA, n = 37) or general anesthesia (GA, n = 36). We measured patients' penile length in both stretched and flaccid states during surgery and compared changes in penile length between the SA and GA groups. We assessed erectile function in patients through a standard questionnaire one month and three months after the surgery. Results: No significant difference was observed in penile length during and two weeks after surgery between the SA and GA groups (P > 0.05). Regarding erectile function, we observed a significant difference in the international index of erectile function (IIEF)-5 score between the two study groups one-month after surgery (P < 0.05). However, there was no significant difference between the SA and GA groups three months after the surgery. Spinal anesthesia had no significant effect on penile length during and two weeks after surgery compared to general anesthesia. Conclusions: Patients undergoing SA may experience transient erectile dysfunction one month after surgery; however, they may develop transient erectile dysfunction, which is recovered three months after surgery.

Anesthesiology and Pain Medicine, Jul 12, 2021

Background: One of the most common devastating problems that occur after urethroplasty is erectio... more Background: One of the most common devastating problems that occur after urethroplasty is erection, which causes surgical complications (fistula, wound dehiscence, and surgical graft failure) and the need for repairing the complications. We attempted to compare the effect of continuous epidural infusion of dexmedetomidine and ropivacaine as a post-surgical erection prevention strategy. Objectives: In this study, we aimed to compare the effect of dexmedetomidine and ropivacaine epidural infusion on the incidence of erection after reconstructive urethral surgery. Methods: An RCT was conducted on 45 patients who were scheduled for reconstructive urethral surgery. They were randomly divided into three groups: (1) control (n = 15), (2) epidural dexmedetomidine (n = 15), (3) and epidural ropivacaine (n = 15). The control group received oral medication after surgery according to the conventional method (cyproterone compound tablets 50 mg BD and diazepam tablets 2 mg TDS for a week) to prevent erection. The DEX group received dexmedetomidine as continuous epidural infusion, and the ROP group received ropivacaine in addition to the conventional method. The occurrence of erection during day and night was recorded separately until the seventh day after surgery. Due to the long-time interval between case selection, participants from different groups were not matched with each other. Results: The incidence of erection in the dexmedetomidine group was lower than that in the ropivacaine group per person (0.87) and significantly lower than in the control group (2.8 per person). Also, there was significantly less erection in the ropivacaine group (1.2 per person) than in the control group. Our study showed that erection after surgery significantly decreased with the continuous epidural infusion of dexmedetomidine and ropivacaine. Conclusions: Dexmedetomidine seems to have a significant preventive effect on erection after reconstructive urethral surgery.

In this article, we present a pregnant case suspected of COVID-19 with underlying symptoms of res... more 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.

Novelty in Biomedicine, Aug 13, 2021

Background: Airway management is always of great concern for anesthesiologists especially in the ... more Background: Airway management is always of great concern for anesthesiologists especially in the prone position. Utilizing an Armored endotracheal tube is considered to be safe in such patients. Cases Report: In this current case, we introduce a patient undergoing a wake-up test during spinal surgery who suffered from hypoventilation at the end of surgery. His condition improved only after extubation. After extubation, we confronted a herniated cuff that was not deflated, although we tried twice. We concluded that the patient's respiratory effort against obstructed airway produced a negative pressure, which made the cuff herniated, resulting in airway obstruction. Moreover, the patient biting the tube during the wake-up test damaged the tube and cuff deflation pathway. Conclusion: It is important to consider cuff herniation as a cause of obstruction when other possible etiologies are ruled out.

International Clinical Neuroscience Journal, Sep 28, 2020

Cystic fibrosis (CF) is an autosomal recessive complaint that disturbs one in 2000-3000 live birt... more Cystic fibrosis (CF) is an autosomal recessive complaint that disturbs one in 2000-3000 live births. It is a multi-organ disease and has a diversity of performances. The primary clinical structures affect the gastrointestinal and respiratory areas. Pre-and postoperative care must focus on the ideal clearance of viscous respiratory secretions. We present an anesthesia technique showed on a 24-years-old men CF case receiving general anesthesia for Arnold Chiari malformation (ACM) surgery.

Journal of Cellular & Molecular Anesthesia, Mar 30, 2020

Background: sore throat as one of the common postoperative challenges, with a prevalence of 65%, ... more Background: sore throat as one of the common postoperative challenges, with a prevalence of 65%, mandates more attention. Many therapeutic approaches have been tested; including ketamine gargle. This study compares the effect dexmedetomidine versus ketamine, both used as preoperative gargle, on the incidence and severity of postoperative sore throat in emergency surgical procedures. Materials and Methods: All patients undergoing emergency surgical procedures who referred to Shohadaye-Tajrish Hospital and needed anesthesia using succinylcholine for rapid sequence induction were considered as the target population and patients with ASA class 1-2, who aged 18-64 years, were enrolled. Inside the operating theatre, patients' vital signs recorded and they were divided into ketamine and dexmedetomidine groups, each including 20 patients, receiving 0.5 mg/kg ketamine or 0.25µg/kg dexmedetomidine in 100cc water to gargle before induction of anesthesia. Standard similar anesthesia protocols were applied for all patients. In PACU sore throat was assessed using a visual analog scale (VAS) scoring. Results: in the ketamine group, 8 cases and in the dexmedetomidine group, 12 had dry throat (p= 0.150). The mean severity of the postoperative sore throat was 2.10± (minimum score of one and a maximum of 3) without significant difference between the two groups (p=0.344). mean diastolic pressure and SpO2 were significantly lower in the dexmedetomidine group compared with the ketamine group (p=0.047 and 0.001). Conclusion: both dexmedetomidine and ketamine gargle could be equally useful and effective in reducing postoperative sore throat.

DOAJ (DOAJ: Directory of Open Access Journals), Mar 1, 2021

Background and Aim: In light of the high prevalence of COVID-19 and the need for ventilation supp... more Background and Aim: In light of the high prevalence of COVID-19 and the need for ventilation support, various methods have been recommended to decrease the need for mechanical ventilation support. In the present study, we made an attempt to compare the effects of rose oil and peppermint extract nebulizer on SpO2 (peripheral oxygen saturation) in COVID-19's patients. Materials and Methods: This study was conducted on 60 patients with COVID-19 under a standard treatment protocol at the Northeast Corona Center of Tehran. The patients were divided into three groups, i.e. peppermint (n:20), rose oil (n:20) and the control (n:20). The peppermint group received peppermint oil nebulizer twice a day (12 drops in 30cc sterile water for each time), the rose oil group received rose oil nebulizer twice a day (12 drops in 30cc sterile water for each time) and the control group received sterile water with nebulizer (30cc sterile water). SpO2 without extra O2 support was recorded before the start of the nebulizing every day up to 3 days. Results: The results revealed that the mean SpO2 significantly increases over time in all the three groups (P-value<0.001). The mean SpO2 was 84.97±0.5 before the treatment, but it was increased to 86.83±0.4 , 88.32±0.4, and 89.93±0.4 at the first, second and third days of the treatment respectively. The daily increase was statistically significant (P-value<0.001). The results showed that mean SpO2 of the peppermint group was significantly more than the control group at the third day of the treatment. The difference in saturation was 3.25% and the p-value was 0.004. Hence, the need for mechanical ventilation reduced and the patients' satisfaction increased. Conclusion : The patients experiencing decreases in SpO2 who were treated with peppermint extract showed better results than those treated with placebo at the third day.

Tehran University Medical Journal TUMS Publications, Aug 10, 2021

Advances in Bioscience and Clinical Medicine, Jan 28, 2020

Background: The best arteriovenous access in diabetic patients under dialysis is crucial to attai... more Background: The best arteriovenous access in diabetic patients under dialysis is crucial to attain better therapeutic outcomes and improved prognosis in the patients. The purpose in this study was to compare the primary patency and maturation rate of antecubital artriovenous fistula for dialysis in diabetic patient with two methods: regional block with Ropivacaine 0.5% and local anesthesia with lidocaine 2%. Methods and Materials: In this randomized clinical trial, 40 consecutive diabetic patients under dialysis in 2016 and 2017 in a training center were enrolled and the primary patency and maturation rate of antecubital artriovenous fistula were compared with regional block with Ropivacaine 0.5% versus local anesthesia with lidocaine 2%. Results: The results in this study demonstrated that all factors of final arterial and venous diameter, blood flow, and patency were higher in group under regional block with Ropivacaine 0.5% and all except patency showed significant difference (P < 0.05). The complications rates were alike across the groups (P > 0.05). Conclusion: Totally, according to the obtained results, it may be concluded that regional block with Ropivacaine 0.5% is superior to local anesthesia with lidocaine 2% leading to higher patency rate and shorter maturation time and also higher arteriovenous diameter and blood flow.

$Research paper thumbnail of Sympatholytic and Anti-Inflammatory Effects of Ropivacaine and Bupivacaine After Infraclavicular Block in Arterio Venous Fistula Surgery$

Anesthesiology and Pain Medicine, Feb 10, 2019

Background: Various mechanisms have been suggested for analgesic effects of drugs used in infra-c... more Background: Various mechanisms have been suggested for analgesic effects of drugs used in infra-clavicular block and each has contributed to pain relief. Objectives: The aim of this study was to compare the degree of sympathetic block and measure tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and IL-1 levels before and after infra-clavicular block with ropivacaine and bupivacaine in patients undergoing arterio venous fistula (AVF) surgery. Methods: Forty-eight patients undergoing AVF surgery were randomly divided to two groups, undergoing infra-clavicular block with ropivacaine and bupivacaine. The bupivacaine group was blocked with 30 mL of 0.5% bupivacaine and in the ropivacaine group, the blockage was done with 30 mL of 0.5% ropivacaine. Infra-clavicular block was carried out by ultrasound in a vertical manner. Blood samples were taken before the block and one hour after the block to measure IL-1, IL-6, and TNF-alpha. Data were analyzed by covariance analysis and correlation t-test. Results: T-correlation analysis showed that in both ropivacaine and bupivacaine groups, the TNF-alpha, IL-6, and IL-1 levels decreased after the block. Also, the increase in arterial diameter was significantly greater in ropivacaine group. Conclusions: The present study showed that peripheral block with any single drug could reduce pre-inflammatory factors. On the other hand, ropivacaine significantly increased the diameter of the artery compared to the bupivacaine group.

DOAJ (DOAJ: Directory of Open Access Journals), Sep 1, 2019

serious complications. In addition, proper communication between health care providers and precis... more serious complications. In addition, proper communication between health care providers and precise checking of drugs labels before injection can dramatically decrease these events.

Journal of Iranian medical council, Jan 24, 2022

The objective of this study was to compare the duration of analgesia, need for analgesic medicati... more The objective of this study was to compare the duration of analgesia, need for analgesic medications, and pain-related nursing interventions in patients who did and did not receive ultrasound-guided femoral nerve blocks for femur fracture pain. Methods: This is a retrospective, preimplementation and postimplementation cohort study. An emergency department log of patients receiving femoral nerve blocks for femur fracture pain was compared with a similar cohort of patients with femur fractures who did not receive nerve blocks. The primary outcome is time from initial pain treatment until the next dose of analgesic. Data were analyzed using Kaplan-Meier methods. Secondary outcomes include number of doses of pain medication, total amount of morphine given, and number of pain-related nursing interventions. Data were analyzed with the Mann-Whitney U test. Results: Eighty-one patients met inclusion/exclusion criteria: 50 in the preimplementation cohort and 31 in the postimplementation group. The median times until next dose of analgesic medication were 2.2 hours (interquartile range [IQR], 1.2Y3.4 hours) in the preimplementation group and 6.1 hours (IQR, 3.8Y9.5 hours) in the postimplementation group (P G 0.001). The median numbers of doses of pain medication were 0.3 per hour (IQR, 0.25Y0.5 per hour) in the preimplementation group and 0.15 per hour (IQR, 0.07Y0.3 per hour) in the postimplementation group. The median total doses of morphine were 14.8 Hg/kg per hour (IQR, 9.4Y19.2 Hg/kg per hour) in the preimplementation group and 6.5 Hg/kg per hour (IQR, 0Y12.2 Hg/kg per hour) in the postimplementation group (P = 0.01). The median numbers of nursing interventions were 0.4 per hour (IQR, 0.25Y0.5 per hour) in the preimplementation group and 0.15 per hour (IQR, 0.1Y0.2 per hour) in the postimplementation group (P G 0.001). Conclusions: Patients who received ultrasound-guided femoral nerve block for femur fracture pain had longer duration of analgesia, required fewer doses of analgesic medications, and needed fewer nursing interventions than those receiving systemic analgesic medication alone.

Archives of anesthesiology and critical care, Jun 2, 2021

Achondroplasia is the result of a mutation in the gene encoding the type 3 receptor for a fibrobl... more Achondroplasia is the result of a mutation in the gene encoding the type 3 receptor for a fibroblast growth factor. This abnormality results in malformation endochondral ossification. Achondroplasia is characterized by disproportionately short stature, lumbar lordosis, large head, midface hypoplasia, short hands, and normal cognitive development. Our report is about a 28-year-old patient with achondroplasia who underwent surgery for correction of kyphosis due to spinal canal stenosis. In this present case we study management anesthesia.

Novelty in Biomedicine, Mar 12, 2020

Background: The purpose of this study was to compare the effect of analgesia of Ropivacaine and m... more Background: The purpose of this study was to compare the effect of analgesia of Ropivacaine and magnesium sulfate as subcutaneous infiltration at the site of surgical cutaneous cholecystectomy in the postoperative period. Materials and Methods: To achieve the research goals, 80 patients referred to Shohada Tajrish Hospital in Tehran in 2016, which were randomly divided into two groups: Ropivacaine and magnesium sulfate. Patients in both groups had similar anesthetic procedures and all of them were monitored standard were recorded within 24 hours of operation. Overall morphine dose was also recorded for postoperative pain. Results: The findings showed that there was a significant difference between the two groups in the Ropivacaine group in the next hours despite the no significant difference in age, sex, BMI, duration of operation and pain scoring at first and third hours. In addition, the comparison of the number of requests for at least one dose of morphine in the Ropivacaine group is significantly lower. In addition, the comparison of the number of requests for at least one dose of morphine in the Ropivacaine group is significantly lower. The occurrence of PONV is also higher in the magnesium sulfate group, but this difference is not significant. Conclusion: Local injection of Ropivacaine reduced acute pain after open cholecystectomy surgery in comparison to local injection of magnesium sulfate. In addition, the use of Ropivacaine is associated with a significant reduction in the need for intravenous morphine for analgesia.

International journal of cancer management, Feb 24, 2020

Background: The use of regional methods in various types of surgery such as mastectomy is very po... more Background: The use of regional methods in various types of surgery such as mastectomy is very popular today. Various methods, including Pecs I-II block, erector spinae, epidural thoracic, and paravertebral block have been used in these operations, each with its own advantages and disadvantages. Recent studies on the effect of µ receptor stimulation on the likelihood of recurrence and metastasis have been published, which make the use of a suitable regional approach with low complications and high efficacy attractive. Among the side effects of breast surgery in patients with cancer are nausea and vomiting, the risk of which is reduced through regional procedures that reduce the need for opioids. Methods: We randomly divided 64 patients into two pectoralis block (Pecs B) and erector spinae block (ESB) groups. Visual analogue scale (VAS) scores at 2, 4, 6, and 10 hours, nausea and vomiting, need for opioids, and hemodynamic changes were recorded. Results: The analyses showed that pain score was significantly higher in the Pecs B group compared to the ESB group, while VAS score, as well as the frequency of opioid use, were lower, which could be due to medial branch of the anterior intercostal nerve. Hemodynamic changes were also significantly greater in the ESB group, which could be due to the proximity of the block to the thoracic sympathetic nerves and spinal cord. Conclusions: Despite the statistically significant differences in analgesia and hemodynamic changes, the seemingly superiority of the Pecs B is not clinically significant and the use of both types of the block is selective. Regarding the need for opioids and nausea, Pecs B showed a tangible advantage over ESB.