Journal of

Introduction: Hemodialysis through creation of arteriovenous fistula (AVF) is an established surgical procedure for patients with End Stage Renal Disease (ESRD). Anesthetic methods management for this surgery should deal with different risk factors such as hypertension, ischemic heart disease and diabetes. Intravenous Regional Anesthesia (IVRA) or Bier block anesthesia as an option for AVF creation has reportedly been attributed to some advantages over other techniques in AVF creation. The present study aims to evaluate the efficacy of Bier block in AVF creation and compare its efficacy with local anesthesia. 

Methods: The subjects of the study were the patients (n=60, aged 20-65 years), who had been admitted for an AVF creation. The patients were divided into two randomly assigned matched groups: Local Anesthesia (LA) group and Intravenous Regional Anesthesia (IVRA) group. 

Results: The patients’ satisfaction levels, simplicity and feasibility of the procedure in the IVRA group were higher, compared to the LA group (94.1%, 66.7%, and 4.85% vs. 82.8%, 51.7% and 3.5%, respectively). However, these differences were not statistically significant.

Conclusions: The two main advantages of Bier block technique are the simplicity of operation and provision of a bloodless field for surgeon. It provides maximum dilatation in veins through the injection of the anesthetic drug and placing a tourniquet on it.

Nasogastric tube (NG) insertion is a usual technique in any neonatal intensive care unit. This procedure is undertaken for the children who are in need of invasive care. Sometimes, the insertion of nasogastric tube in infants with esophagus friable anatomy tissues may have some dangerous side effect, but such problems are not very common. Esophageal perforation is a rare but known complication of these procedures. In this study, we present the case of an infant with esophageal perforation. This infant was diagnosed incidentally on X-rays. This problem is usually associated with critically ill patients in the NICU.

• In traumatic brain injury many objects may enter the cranium, if these injuries are associated with the entry of contaminated foreign bodies into the brain; they can cause more damage and complications. This is a case report of such patients with different aspects of treatment. We reported a case followed motor accident suffered dirty large scalp lacerations, multiple linear and depressed skull fractures, and exposure to dura matter, pneumocephalus, and many sands and soil under the cranium. Several therapeutic actions were done including adequate irrigation, administration of Prophylactic antimicrobial and anticonvulsant therapy, and early surgical intervention. The Patient did not show any signs or symptoms of infections or other complications during the hospitalization period and he had a favorable 10-month follow-up period. We concluded in penetrating brain injury with contaminated foreign bodies, adequate irrigation and early administration of prophylactic antibiotic therapy and antiepileptic agents associated with early neurosurgical intervention can be helpful in complications prevention.