Background: During the four steps of the VALSALVA MANEUVER (VM), opposite changes can be observed in some physiologic parameters. Manifestations of the VM in the electrocardiogram (ECG) have been studied in detail, but there have been few reports comparing VM-related biochemical and hemodynamic changes with a focus on the strain phase of the VM.Objectives: We studied strain-related ECG changes during the VM.Patients and Methods: This self-control descriptive study was conducted in 20 healthy male college students aged 20.12±2.23 years. They were well trained to perform the standard VM: maintenance of a 15-second expiratory pressure at 40 mmHg with open glottis. An ECG was continuously recorded in the supine position at (a) rest (before the VM) and at (b) the start and (c) end of strain maintenance in the second phase of the VM. The averages of four successive beats were computed for each set of (a), (b), and (c). Means±standard errors of the mean were used for comparison.Results: Following the VM, the RR and PR intervals, corrected QT interval (QTc), P wave duration and amplitude, T wave amplitude, and the ratio of T/R amplitudes showed significant changes. The QRS duration and R wave amplitude did not show significant changes.Conclusions: The VM caused time and voltage changes in some ECG waves during the strain phase. Alterations in heart or lung volume, electrode-related alterations, and autonomic tone may cause these changes.

Background: The prevalence of varicocele in employees of musician and transport units of AJA University of medical sciences was evaluated.Materials and Methods: In a cross-sectional study 42 musician and 31 individuals from transport unit of AJA University of medical sciences enrolled. The varicocele was evaluated in left and right testis. The prevalence and grad of varicocele were analysed by X2 and P<0.05 was statistically considered significant.Results: The results showed that the prevalence of varicocele in the musician unit (31%) was significantly higher than in the transport unit (10%) (P=0.032), and in the left testis was significantly higher than the right testis. The grad of varicocele in the musician unit was also significantly higher than the transport unit.Conclusion: It seems that the prevalence and grad of varicocele in the left testis are higher than in the right testis and are also high in musicians who their activities are accompany with VALSALVA manoeuvre.

VALSALVA MANEUVER (VM) is associated with rapid, intense changes is systolic blood pressure (SBP) and heart rate (HR). It is considered to cause lethal arrhythmia and sudden cardiac death in patients with cardiovascular disorders, especially those with coronary artery disease. Intensity of cardiovascular responses to the VM probably could depend on cardiac preload and venous return which is varied in different body positions. This research was under taken to determine the degree of changes of SBP and HR during the VM in three, positions (flat, 70 elevated and sitting leaning forward) . The method of sequential and convenience sampling has been used for the selection of units under study: Based on study criteria, 42 individuals (21 males, 21 females) were selected. Cardiac monitoring was used to measure HR. Subjects produced a VM of 40 mmHg for 10 seconds in each of three positions. The cardiac monitor recorded the HR continuously and SBP was obtained before, during and after the VM. The results showed that the body position may affect the intensity of SBP and HR changes during the VM. This was verified by friedman analysis of variance (P=0.0000) and repeated measurements of the analysis of variance (P=0.000).The widest range in SBP took place in the 70 elevated positions. The narrowest range of changes in SBP and HR occurred in the flat position. It was concluded that the intensity of SBP and HR changes in sitting and leaning forward position significantly differed from 70 elevated position (P= 0.000). Also, no significant difference from flat position (SBP changes, P= 0.07 and HR changes, P=0.12) was observed. In addition, the sitting and leaning forward position would appear to be superior to other postures during unavoidable VM, especially in patients with coronary artery disease.    

To the Editor: Pain is a physiological but unpleasant reaction during nursing procedures. Also, to help a person grasp an internal or external threat, pain is regarded as an emotional sense and experience linked to tissue damage [1]. . . .

Introduction: The use of vagal nerve stimulation is identified as a proper treatment option in patients with stable supraventricular tachycardia (SVT). This study aimed to assess the success of VALSALVA MANEUVER via a handmade device in reversion of SVT.Methods: In this quasi experimental study, using a handmade device, vagus nerve stimulation was performed for SVT patients presenting to emergency department or cardiac intervention unit and the success rate and its related factors were assessed.Results: 100 patients with the mean age of 53.05± 13.70 years were studied (67% female).12 (12%) cases were unable to do the MANEUVER. Out of the 88 (88.0%) patients who could perform the MANEUVER, 75 (85.2%) cases were unsuccessful. Dysrhythmia was controlled in 6 (6.8%) cases on the first attempt and in 7 (8.0%) cases on the second one (14.8% total success rate).12 of the 13 cases (92.3%) of successful MANEUVER had history of SVT (p=0.031). There was not any significant association between success rate and sex (p=0.084), age (p=0.744), or other medical histories (p³ 0.05).Conclusion: Based on the results of the present study, the success rate of VALSALVA MANEUVER with the mentioned handmade device was calculated to be 14.8%. The only independent related factor of successful reversion was SVT history.

Background & Aims: Venous cannulation is a painful and stressful methodin health care sitting that various medical and non pharmacological methods are used in to reduce its pain. This study was conducted to investigate the effect of VALSALVA MANEUVER on pain intensity and hemodynamic changes during IV cannulation. Materials & Methods: In a clinical trial, 80 patients scheduled for elective surgery who were admitted to surgical wards, in Hazrat Rasol (Javanroud 2016) were studied. Convenience Sampling was used and assignment to two groups was randomly. In VALSALVA group (blowing the plastic tube connected to a mercury sphygmomanometer and raising the mercury column up to 20 mm Hg for at least 20 seconds) 39 patients and 38 patients in control group (usual procedure) cannula was inserted on the back of the non-dominant hand. The pain intensity was measured by a Numerical Rating Scale (NRS). Hemodynamic responses to pain were measured by controlling blood pressure, heart rate and arterial blood oxygen saturation five minutes before and immediately after cannulation. The data was analyzed with chi-square tests, ANOVA, Tukey, Kruskal-Wallis and Mann-Whitney tests using SPSS software (version 16). Results: The Mean NRS in VALSALVA group was 2/75 ± 1095 and in control group was 4. 86 ± 2. 30, which showed a significant decrease in pain severity (P≤ 0. 05) The heart rate decreased from (80. 53 ± 14. 71) to (77 ± 13. 36) after cannulation in the control group (P≤ 0/05). While other hemodynamic variables did not show significant difference. Conclusion: The VALSALVA MANEUVER is a non-pharmacological method that can be easily performed and reduces cannulation pain without making hemodynamic changes.

Aims and background: Pain on injection is a limitation of propofol use. Therefore, it is important to lower the pain on injection of Propofol in patients undergoing anesthesia. As a result, the current study was conducted in order to compare the effects of lidocaine, lidocaine and the VALSALVA MANEUVER, and the VALSALVA MANEUVER on decreasing the pain of Propofol injection. Material and methods: This study is a clinical trial with 111 patients. The patients were allocated into 3 groups with one group receiving lidocaine, the second group receiving lidocaine and the VALSALVA MANEUVER, and the last one VALSALVA MANEUVER solus. The pain resulting from injecting Propofol based upon the Visual Analog Scale (VAS) score were analyzed using the Mann Whitney U test. A P value of <0. 05 was considered significant. To compare the means between or within independent groups, the independent samples t-test or the one-way ANOVA test was used. The chi-square test or the Fisher’, s exact test were used to compare proportions as appropriate. We used the SPSS 23. 0 statistical software package for all analyses. results: The mean pain score in the combination group of lidocaine and VALSALVA MANEUVER was lower than the other two groups and was equal to 0. 5 ±,0. 33. In addition, the mean pain scores in the lidocaine group and the VALSALVA MANEUVER group were 4. 6 ±,1. 41 and7. 81±, 1/91, respectively. The mean pain intensity in the age groups and the sexes did not show a significant difference with each other. Conclusion: The current study showed that the injection of Propofol in the three groups of this study was reduced in a similar fashion, however in the group which combined lidocaine, VALSALVA and the VALSALVA MANEUVER, pain was lowest, but the overall score in the three groups was not statistically different.

In order to determine the effect of VALSALVA MANEUVER and head rotation on the internal jugular vein (IJV) diameter and cross-sectional area and overlap with the carotid artery (CA) and find the best technique for safe cannulation of the IJV and decrease the risk of CA puncture, the diameter of both the IJV and the CA and percentage of overlap between the two vessels and cross-sectional area of the IJV were measured by ultrasonography on the right side of the neck in the supine, head down position, at three different degrees of head rotation with and without the VALSALVA MANEUVER in 30 subjects. The results were analyzed by two-way repeated- measures analysis of variance followed by least significant difference (LSD). Head rotation increased the overlap between the two vessels (p<0.001). VALSALVA's MANEUVER also increased overlap between the twp vessels (p<0.02) and increased IJV diameter and cross-sectional area (p<0.001).Head rotation did not change IJV diameter and cross-sectionalarea significantly (p>0.05). VALSALVA's MANEUVER and head rotation did not change CA diameter significantly (p>0.05). Wetherefore advocate the neutral head position with VALSALVA's MANEUVER as a safe and reliable method for IJV cannulation.      

Objectives: The purpose of this study is a comparison of VALSALVA, lidocaine, and VALSALVA with administration of lidocaine to reduce the pain associated with administration of etomidate. Methods: The present study is a clinical trial study. The number of samples in each group was 30 and a total of 90 people were selected. This study was a clinical trial and the subjects were randomly divided into three groups: Group 1: VALSALVA, 2: Lidocaine, 3: VALSALVA and Lidocaine. Pain due to etomidate was rated on a VAS from 1 (painless) to 3 (worst imaginable pain) and their information was recorded. The collected information was entered into SPSS 22 and analyzed with appropriate statistical tests. Results: A total of 90 subjects participated in the present study and were divided into 3 groups: VALSALVA, lidocaine, and VALSALVA with lidocaine. No signifi cant diff erence was observed between demographic variables in the study groups. There was a signifi cant relationship between severity of pain in the three groups. According to the results, the highest pain intensity was in the VALSALVA group and the lowest pain intensity was in the VALSALVA with lidocaine group. Conclusions: VALSALVA with lidocaine reduces the severity of pain caused by etomidate to a greater extent than other groups.

Introduction: Propofol is one of the most common anesthetic drugs. Painful injection with a reported prevalence of 28 to 90% in various studies is one of the problems of taking Propofol. The present study investigated the effect of performing the VALSALVA MANEUVER and tourniquet twisting on pain intensity and hemodynamic changes. Materials and Methods: This clinical trial was performed on 105 patients under general anesthesia with propofol that was randomly divided into three groups VALSALVA, tourniquet, and control. Pain caused by propofol injection was evaluated using the withdrawal response score from 0 (painless) to 3. Hemodynamic parameters including blood pressure (systolic, diastolic, mean arterial), heart rate, and oxygen saturation level have been measured too. Results: Statistical analysis showed that there was no significant relationship between the distribution of pain intensity among the three groups, however the frequency of people with moderate pain intensity and painless in the tourniquet and VALSALVA groups increased significantly compared to the control group. There was also a significant correlation between blood pressure systolic, diastolic, mean arterial (P=0. 0001), and heart rate (P=0. 013) in the three groups, and no significant difference was observed between oxygen saturation levels in the three groups (P=0. 102). Mean blood pressure in the VALSALVA group and heart rate in the tourniquet group is higher than in other groups. Conclusion: VALSALVA MANEUVERing and tourniquet twisting reduce the pain caused by propofol injection, with the difference that the mean blood pressure in the VALSALVA group is greater than that in the tourniquet group.