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Article
Evaluation of the Analgesic Effect of Four Intra-Articular Ozone Injections in Knee Osteoarthritis

Author: Iyad Abbas Salman
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 2 Pages: 211-214
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Knee osteoarthritis (OA) is a degenerative disease of the knee joint. There is no cure for the disease, but some treatments attempt to slow disease progress.Intraarticular ozone injection is increasingly being applied. In knee osteoarthritis it represents a complementary treatment method which provides pain relief, decongestion, subsidence of bruises (hematomas), a reduction in temperature and an improvement in motility.OBJECTIVE: To evaluate the analgesic effect of 4 subsequent intra-articular ozone-oxygen injections in knee joint osteoarthritis. PATIENTS AND METHODS:It was a prospective, randomized clinical study, done on 30 knee joints, all patient were with history of OA of knee joint & suffering from long standing pain & they have long history of medical therapy. After taking patient consent, 5 weekly sessions of intra-articular 5 ml (25 μg/ml ) ozone injections were done under complete aseptic technique. Numerical Analog Pain score has been assessed and recorded before each session.RESULTS: It was found that there was highly significant difference between each 2 subsequent sessions and the p-value was below 0.01 in all times.CONCLUSION: Subsequent Intra-articular ozone injection had significant analgesic effect in knee joint osteoarthritis


Article
A comparison Between the Transversus Abdominis Plane (TAP) Block Versus Traditional Parentral Analgesia Post Caesarian Section

Authors: Iyad Abbas Salman --- Hayder Saad Kamel
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: supplement Pages: 718-723
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Postoperative pain, especially when poorly controlled, results in harmful acute effects (i.e., adverse physiologic responses) and chronic effects (i.e., delayed long-term recovery and chronic pain).The transversus abdominis plane (TAP) block is a new method of providing postoperative analgesia in patients undergoing lower abdominal wall incisionsOBJECTIVE:To compare the effectiveness of TAP block versus traditional parenteral analgesia post caesarian section.PATIENTS AND METHODS:A prospective randomized double blinded placebo controlled clinical trial conducted in the department of obstetrics & gynecology of medical city complex. over a period of four months from 1st of November to 1st of march. Fifty women patients were selected to be enrolled in this study who were scheduled for C.S. via pfannenstiel incision, all patients were of ASA I- II physical status. Twenty five of them were given TAP block with (bupivacaine 0.25%) & placebo i.v saline (0.9%) , the other twenty five were given i.v tramadol & i.m diclofinac sodium & placebo TAP block with normal saline 0.9%.Numerical rating scale was used to follow up the patients postoperatively at 2,6,12,16 hours.RESULTS :By comparing the means of numerical analogue scale score over the time there was a significant difference in mean score over the time, the traditional treatment had better effect on relieving pain only at the 1st 2 hours where TAP block was better on the rest time with a highly significant difference P.value < 0.05 in all comparisons.CONCLUSION:TAP block is not effective as sole analgesic, but is effective in reducing the frequency of doses of incremental analgesia. TAP block is more effective than traditional analgesia in reducing the mean of pain score .The traditional parentral analgesia require more frequent dosing.


Article
Comparison of the Hemodynamic & Respiratory Parameters between Smokers & Non Smokers in Lower Abdominal Surgery Under General Anesthesia

Authors: Iyad Abbas Salman --- Musrey Younis Jahn
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 202-207
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: BACKGROUND:Smoking is a very widespread habit , it had been proved to affect adversely on many systems of the body especially the cardiovascular (CVS) & the respiratory system, and such effects wouldbe exaggerated perioperatively because of the effect of general anesthesia (GA) especially whenthere is no any period of abstinence from smoking (as when occurred during emergencyprocedures).OBJECTIVE: To assess the hemodynamic & respiratory effects of smoking perioperatively in patientsundergoing emergency lower abdominal operations. PATIENT AND METHODS: A prospective case control study carried on 80 patients in Baghdad teaching hospital/Medicalcity / Baghdad / Iraq, from September 2011 to March 2012, the 80 patients have been allocatedinto 2 groups, (each of 40 patients): group 1 who were non smoker patients, & group 2 thesmoker patients. The 2 groups were undergone emergency lower abdominal surgery under GA, all the patientsreceived similar pre. & intraoperative managements. Pulse rate (PR), systolic blood pressure(BPsys), diastolic blood pressure (BPdias),oxygene saturation (SPO2), and airway pressure(Paw) were monitored with the standard non invasive technique, at the baseline period(preoperative); immediate postintubation; 10, 20, 30, & 40 minutes intraoperatively; immediatepostextubation; & 10 minutes in the recovery period.RESULTS: Regarding the pulse rate, there were no statistically significant variations between the 2 groupsapart from the immediate postextubation period (105 ± 6.95 in smokers vs 100.3 ± 8.3 in nonsmokersRegarding the systolic blood pressure, there was statistically significant increase in the systolicBP especially at the immediate postintubation period in smoker patientsRegarding the diastolic BP, apart from the immediate postextubation period ,there wassignificant increase in the diastolic BP between the 2 groups especially at the immediatepostintubation Regarding the SPO2%, there were no statistically significant reduction in the SPO2 readingsbetween the 2 groups apart from the intraoperative period Regarding the P airway , there were no significant increase in the P airway perioperativelybetween the 2 groups CONCLUSION: There were statistically significant CVS derangements in the smoker group versus the nonsmokers especially around intubation period.

Keywords

smoking --- hemodynamic --- respiratory


Article
Comparison between Total Intravenous Anesthesia (TIVA) and Conventional General Anesthesia in Day Case Surgical Procedures

Authors: Iyad Abbas Salman --- Ali Yousif Mohammad
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: supplement Pages: 700-705
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Day case surgery should be of short duration, rapid recovery, and with low incidence of postoperative complications. For long time was done with conventional inhalational based anesthesia, in last year's, TIVA began to be used in these surgeries.OBJECTIVE:To evaluate total intravenous anesthesia (TIVA), as an aesthetic technique for day case procedures and to compare it with conventional inhalational based technique in terms of intra and postoperative hemodynamic and respiratory changes, postoperative recovery and postoperative vomiting.PATIENTS AND METHODS: This is a prospective randomized study has been done on 100 patient who underwent general anesthesia for short duration surgical procedure in AL- Jumhory teaching hospital in Al-Mosul city in Iraq, during the period between Nov 1st, 2011 and March 1st, 2012 , All patients were allocated into either TIVA or inhalational (INH) groups, of 50 patient each. In TIVA group: induction and maintenance of anesthesia done by propofol. While in INH group: maintenance of anesthesia done by halothane. Blood pressure, pulse rate, respiratory rate were monitored at a specific time. Recovery time was recorded according to Aldrete score. Any episode of vomiting was recorded.RESULTS: Aldrete score of ≥ 9 was achieved earlier in the TIVA group than in the INH group. It was also observed that there was initial fall in HR, MAP and respiratory rate in the both group, and post operative vomiting was less in the TIVA group.CONCLUSION: The time needed for recovery and episodes of postoperative vomiting in TIVA is less than in inhalational anesthesia.KEYWORDS: TIVA, propofol, day case surgery.


Article
Comparison between the Clinical Assessment, Peripheral Nerve Stimulation (PNS), and Acceleromyography (AMG) to Reverse Neuromuscular Blockade

Authors: Iyad Abbas Salman --- Mortada A. Jubara
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 2 Pages: 146-152
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: BACKGROUND:Traditionally, most of anesthesiologists in Iraq evaluate the degree of neuromuscular blockade during and after anesthesia using clinical criteria alone, which are inaccurate to assess adequate recovery from neuromuscular block (NMB) which is essential for the patient to have full control of pharyngeal and respiratory muscles. Fade cannot be detected reliably with a peripheral nerve stimulator (PNS) at a TOF ratio > 0.4. The time gap between losses of visual fade by using a PNS until objective TOF ratio has returned to > 0.90 can be considered “the potentially unsafe period of recovery.” OBJECTIVE: To compare between assessment of subjective clinical, subjective TOF by peripheral nerve stimulation (PNS), and objective TOF by acceleromyography (AMG) before reversal of neuromuscular blockadePATIENT AND METHOD: A prospective clinical trial of one hundred females who underwent caesarian section under general anesthesia. Standard anesthesia was conducted for all patients. Giving of neuromuscular reversal was decided by the anesthesia care providers depending on clinical criteria, at that time, TOF measured by 2 ways, 1st: counting the twitches visually (principal of PNS), and 2nd: the device showing the TOF reading objectively (principal of AMG).RESULT: Comparisons between subjective criteria and objective AMG T4T1 ratios revealed no statistical significance (P > 0.05) in all comparisons (except that with the moving limb and lift the head). The association and consistency of subjective criteria and visual PNS was insignificant differences in all comparisons. There was wide discrepancy between objective reading and the visual PNS. CONCLUSION: The moving limbs and sustained lift head 5 seconds clinical criteria were correlated to TOF. Other criteria (protruding tongue, respiratory effort, and swallowing reflex) were not correlated to TOF. Objective AMG more sensitive to detect the fourth twitch than the subjective PNS. KEY WORDS: train of four (TOF), peripheral nerve stimulator (PNS).


Article
A Comparison of Using Ketamine Versus Combination of Ketamine and Thiopentone in Short Painful Procedures in Pediatrics

Authors: Iyad Abbas Salman --- Saba J. AL-Wardi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 1 Pages: 103-109
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Short painful procedures in pediatric age group like bone marrow aspiration (BMA) and biopsy taking are day case operations which demand rapid recovery and minimal incidence of postoperative complications.OBJECTIVE: To compare between intra & postoperative complications & the time of stay in the recovery room for pediatrics undergoing short painful procedures under general anesthesia with either "ketamine and thiopental" or "ketamine alone".PATIENTS AND METHOD: THIS IS A PROSPECTIVE RANDOMIZED clinical trial done in Children Welfare Hospital in Medical City, Baghdad, Iraq, from August - November 2010 on 89 children patients who were scheduled for short painful procedures. All patients were allocated randomly into 2 groups: the 1st group (KT) received I.V ketamine 1% (1mg/kg) plus I.V thiopental 1% 3-5 mg/kg (anesthetizing dose) on induction and maintained on intermittent I.V doses of thiopental 1% in case of need. While the 2nd group(K) received I.V ketamine 1% (1.5mg/kg) alone on induction and maintained on intermittent I.V doses of ketamine 1%(0.5mg/kg) in case of need. Any intra or postoperative complications & the duration of recovery for all patients were recorded. RESULTS:It was found that the intraoperative complications (temporary & mild decrease in arterial O2 saturation and its associated breath holding, & cough) occurred more in the KT group, while the occurrence of (mild involuntary movements and verbal responses) occurred more frequently in the K group. The postoperative complications (nausea, vomiting, verbal hallucinations and dizziness) occurred only in the K group. The duration of recovery is more prolonged in the (KT) group.CONCLUSION: The use of combination of thiopentone and ketamine is associated with more mild and temporary intraoperative decreased arterial oxygen saturation, breath holding, and postoperative cough than using ketamine alone, while the use of ketamine alone is associated with more mild involuntary movements and verbal responses, postoperative nausea &/or vomiting, hallucinations, and dizziness. The duration of recovery is prolonged by the use of thiopental.KEY WORDS: ketamine, thiopental, TIVA, pediatrics, day case.


Article
A Comparison of Bupivacaine Instillation and Ultrasound Guided Field Block for Post-Operative Pain Relief in Inguinal Hernia Repair

Author: Iyad Abbas Salman* , Ali Moayed Jwad
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 3 Pages: 248-251
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND: Postoperative pain is a common problem after inguinal hernia repair. Postoperative pain may delay the return to normal activity and delay hospital discharge. Various techniques have been employed to provide postoperative analgesia, by the use of regional anesthetic technique, local anesthesia or traditional analgesic technique: opiates, non-steroidal anti-inflammatory drugs (NSAIDs) or combinations.OBJECTIVE: To compare the postoperative pain relief provided by simple bupivacaine wound instillation and ultrasound guided inguinal hernia field block.PATIENT AND METHOD: A single blind, prospective, randomized controlled clinical trial for 72 male patients who were undergoing elective unilateral inguinal hernia repair. In 37 of them 10 ml of 0.5% plain bupivacaine was instilled (irrigated) into the wound by the surgeon for 1 minute. In another 35 patients, ultrasound guided field block performed using 20 ml of 0.25% plain bupivacaine at the end of surgery. Vital signs, numerical pain score and analgesia requirement were recorded at recovery (zero hour), 1st, 2nd, 4th& 8th hours postoperatively.RESULT: By applying null hypothesis, using the t-student test of two independent samples, pain score and request for analgesia show significant difference only at the first two hours with p-value <0.05, otherwise there was no significant differences in the following hours. For vital signs there was no significant difference for both groupsCONCLUSION: Bupivacaine instillation is as effective as ultrasound guided field block for inguinal hernia repair pain. We recommend this technique in places where ultrasound machine is not available especially in many developing countries.


Article
The Role of Gabapentin in Prevention of Remifentanil-Induced Hyperalgesia

Author: Iyad Abbas Salman*, Bashar Zuhair Talib**
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2018 Volume: 17 Issue: 1 Pages: 1-5
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Remifentanil is widely used as intraoperative analgesic. Post infusion hyperalgesia has been documented experimentally in both animal and human volunteers. Gabapentin has anti-hyperalgesic effect.OBJECTIVE: To evaluate the effect of single preoperative oral dose of 300 mg gabapentin in attenuation of postoperative hyperalgesia induced by remifentanil and the decrease in post-operative analgesic requirement.PATIENT AND METHOD: A prospective randomized clinical trial conducted in Tikrit teaching hospital/ Iraq, at 2013. It involves 60 patients who underwent appendectomy. All patients were randomly allocated into two equql groups (each of 30 patients): First controlled group (CG) didn’t pre-medicated with gabapentine and 2nd gabapentine group (GG) pre-medicated with gabapentin. Intraoperative infusion of remifentanil was used & postoperative pain was assessed in all cases. RESULTS: The numerical analog scale NAS score and analgesia requirement post operatively was significantly higher in most times in the (CG) as compared with those of the (GG).CONCLUSION: Premedication with 300mg gabapentin orally decreased hyperalgesic effect induced by remifentanil and so decreased the pain score and the analgesic requirement postoperatively.


Article
Comparison of the Effect of Dexamethasone and Metoclopramide in Prevention of Post-Operative Nausea and Vomiting in Laparoscopic Cholecystectomy

Authors: Iyad Abbas Salman --- Redha Mohamed Abdul Hussien Alkabee
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 3 Pages: 443-448
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ACKGROUND: Postoperative Nausea and vomiting is Common complication depending on the type of surgery, technique and duration of anesthesia.OBJECTIVE: To evaluate the effect of Dexamethasone as antiemetic in comparison with Metoclopramide.METHODS: Is aprospective study carried on (100) patients undergone elective cholecystectomy in a periodfrom Jan. 2009 to April. 2010 in Baghdad Teaching Hospital / Medical city/Baghdad/Iraq. The patients were allocated into two groups of 50 patients each. Group A received 8mgDexamethasone, group B received 10mg metoclopramide intravenously, both groups monitoredpostoperatively for nausea and vomitting for 24 hours every 4 hours.RESULT:Regarding Nausea, for 24 hrs the results were not significant except at 24th hr., in which nauseamore significant in metoclopramide group.Regarding Vomiting, there was no significant from postoperative period to 12hr, while from 16 hr.to 24 hr. there were significant fewer incidences in dexamethasone group.CONCLUSION: A single dose of Dexamethasone is effective same as Metoclopramide in prevention of PONV ,and it is better in late prevention postoperativel


Article
Time From Giving Reversal to Train of Four 90 %: A Comparison Between Inhalational Anaesthesia and Propofol

Author: Iyad Abbas Salman*, Reem Abbas Naem**, Ali Mohammed Kareem Naji
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2018 Volume: 17 Issue: 2 Pages: 114-120
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND: The train-of-four (TOF) ratio should return to at least 90% to exclude potentially clinically significant postoperative residual block. The time gap between clinical recovery (subjective) until objective recovery (i.e. TOF ratio has returned to _0.90) can be considered “the potentially unsafe period of recoveryOBJECTIVE:To determine the time difference (from giving the reversal drugs till reach TOF90% readings by acceleromyography) between patients maintained on propofol and those maintained on halothane.PATIENTS AND METHOD: A prospective clinical trial study100 females underwent caesarian section divided into inhalational anaesthesia group (maintained on inhalational anaesthesia-halothane) and propofol group (maintained on propofol infusion after delivery of the baby till the end of operation) then recovery is monitored using acceleromyography.RESULT: Times from giving reversal of the muscle relaxant till extubation and time from giving reversal till reading of TOF90% were significantly lower in propofol group than in inhalational group. CONCLUSION: Patients maintained on propofol was extubated earlier than those maintained on inhalational anaesthesia also needed less time to reach TOF90% i.e. inhalational anaesthesia augment muscle relaxation more than propofol..

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