JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2020 | Volume:43 | Issue:1 (109)|Papers Count:10

Introduction: In December 2019, a pathogen, the new 2019 Coronavirus (2019-nCoV), was identified in Wuhan, China, causing outbreaks and eventually spreading around the world. We are facing a new challenge in the post-Corona era. Given that personal protective equipment is not used exactly at the peak of corona prevalence, choosing patients for the non-COVID ICU is challenging, to prevent infection of non-COVID patients and staff. Case presentation: In our intensive care unit, we endorse hospital protocol which is based on the W. H. O protocol for patient admission to ICU. However, despite considering strict rules for patient admission, we detected several COVID patients among the other patients. Symptoms included: lymphopenia, weakness, inability to walk, gastrointestinal symptoms, and conjunctivitis. Conclusion: It seems that we need an intermediate section between the COVID and non-COVID wards, and patients who are to be transferred from the COVID ICU to the non-COVID ward should be hospitalized in this ward for a certain period. Full use of personal protective equipment (mask, gloves, Scrubs, eye protector) is recommended in all the non-COVID ICU.

Objective: The length of hospital stay is an important indicator that can be useful for financial and management planning of hospitals. If patients who are going to stay in the hospital for a long time can be identified immediately after admission, Appropriate resources can be made available to try to speed up health care right from the start. Therefore, due to aging and on the other hand, the long queue for using ICU beds, the present study was conducted to determine the factors related to the length of stay of patients in the neurosurgery ICU of Loghman Hakim Hospital. Materials and methods: This is a retrospective descriptive study. The studied samples were extracted from 543 computer files of patients admitted to the ICU of Neurosurgery of Loghman Hakim Hospital affiliated to Shahid Beheshti University of Medical Sciences in the period 2016-2017. Then, using Spss software version 25, the relationship between each of the variables and the length of stay was analyzed using the chi-square test. Results: Based on the results of the study, the statistical population consisted of 543 patients with a mean age of 18. 07± 43. 34, including 42. 4% female and 57. 6% male. The mean length of stay was 5/86± 6/33days and the factors related to the length of stay of the 15 variables included: diagnosis, hypertension, type of surgery and postoperative complications: pneumonia, meningitis, epilepsy. Conclusion: Using the information obtained from the analysis of the patient length of stay in hospitals, the goal of better allocation of resources and hospital beds and optimal productivity of existing beds can be achieved. According to the findings of this study and by better identifying and managing factors related to length of stay, the length of stay index can be improved and steps can be taken to reduce costs and waste resources.

Background: Patients who were been under mechanical ventilation for more than 48 hours are susceptible to ventilator-induced lung injury (VILI). Lung inflammation and pulmonary activation of coagulation are induced by mechanical stress. Clinical and preclinical studies show that heparin possesses antiinflammatory properties. Therefore, we assessed the effects of nebulized heparin in VILI. Materials and Methods: Sixty critically ill adult patients who require mechanical ventilation for more than 48 hours were included in this prospective, nonrandomized controlled study. Patients received nebulized heparin (10000 U every 6 hours) for 5 days. The matched control group received nebulized budesonide as routine practice in our center. This study assessed changes in partial pressure of oxygen to inspired fraction of oxygen ratio (PaO2/FiO2) and rapid shallow breathing index (RSBI) during the study period as primary endpoints. Results: The average daily PaO2/FiO2 ratio was not statistically significant between both groups (187± 11. 6 versus 171± 11. 6, P: 0. 35). The RSBI also didn’ t differ between groups (P: 0. 58). Heparin administration was associated with a higher number of ventilator-free days among survivors but not significantly (7. 7± 10. 6 versus 5. 1± 8, 95% CI-2. 2 to 7. 5, P: 0. 28). Successful weaning from mechanical ventilation was higher in the heparin group (P: 0. 42). We didn’ t observe any serious or increased adverse effects from nebulized heparin. Conclusion: The results of this study show that the overall effectiveness of nebulized heparin is at least as comparable with a potent corticosteroid (budesonide). Heparin could be a safe and effective modality for patients who at risk of VILI.

Introduction: The administration of uterotonic agents during cesarean delivery is highly variable. The aim of this study was to investigate the comparison efficacy of “ Rule of Threes” algorithm with William’ s guideline in uterine tone evaluations as well as side effects of each approach in the low risk women of elective cesarean delivery (ECD). Materials and methods: This prospective and triple-blind study was conducted in 110 American Society of Anesthesiologists (ASA) physical status I– II patients with low risk of ECD. Based on administration of oxytocin the patients were randomly divided into two groups: group 1 was received oxytocin using Rule of Threes approach; group 2 was received oxytocin using William’ s guideline. In both groups total oxytocin consumption and hemodynamics changes were recorded and compared. Results: The mean dose of oxytocin was 3. 32± 0. 94 (IU)in Rule of Threes versus 6. 00± 0. 00 (IU) for William’ s group, which showed a significant difference between the two groups by independent t-test (P<0. 001). The mean total consumption of methylergonovine was 0. 003± 0. 02 (mg) for Rule of Threes group versus0. 2± 0. 02 (mg) for William’ s group which showed a significant difference between the two groups by independent t-test(P<0. 001). Out of 55 patients at 3, 6, 9, 12, and 15 min 89, 98, 98, 100 and 100 percent patients had adequate uterine tonicity in group Rule of Three, while all of the 55 patients in William’ s group had no adequate uterine tonicity at 3, 6, and 9 min as well as 96 percent of patients had adequate uterine tonicity at 12 and 15 min. No differences were observed in either groups respected to maternal hemodynamics, side effects, or blood loss. Conclusion: In both methods, no abnormal changes in hemodynamics were observed, as well as other complications associated with high doses of oxytocin. The advantages of the Rule of Threes method were high efficacy and shorter time in achieving adequate uterine tonicity, and no second-line treatment was required. Complications such as atony and abnormal bleeding were not observed during the one-day followup.

Considering the special view of planners in the field of maternal health as an indicator of community health and also the existence of people with experience in the field of obstetric anesthesia, we hope to see more anesthesiologist as a fellowship with special abilities in this field soon, so that Iranian mothers make the delivery process safer. . . .

This review has been performed in the summer of 2020 by reviewing recent articles from the PubMed database. The study has been focused on viral infections similar to COVID-19 in terms of treatment options and the benefits of Hemoperfusion in these patients. COVID-19 is highly contagious with respiratory manifestations mainly. Lack of accurate treatment alongside the blatant mortality rate of the disease represents the urgency to achieve an efficient treatment to control this viral infection. Recent researches on the respiratory viral infections especially by coronaviridae (SARS, MERS, Coronavirus) has been revealed the major role of pro-inflammatory cytokines released in the blood, result in forming a cytokine storm syndrome leading to severe sepsis, septic shock, and finally to death. In several case reports, improvements in respiratory manifestations and SPO2 levels after blood purification from cytokines by Hemoperfusion has been demonstrated. Occurrence of adverse effects of hemoperfusion such as bleeding tendencies and hypotension have been limited its routine usage. In conclusion concerning the correctness of the hypothesis: " Is Hemoperfusion beneficial in COVID-19 treatment? " we have to affirm that despite optimistic reports, yet more investigations have to be done for definite judgment.

Introduction: Conversion disorder or functional neurologic symptom disorder is a diagnosis of exclusion in situations which the patients' symptoms and clinical findings(signs) are not consistent with a wellestablished organic reason and is not fully justifiable to make the diagnosis. Conversion disorder can present by very diverse manifestations such as: Aphonia, Motor and sensory loss, Ataxia, Psudoseizure, Dystonia, myoclonus, etc. almost always there is a psychologic trigger for conversion and in fact conversion or somatization is a way of dealing with stress for the human body. On one hand childbirth is a stressor of great magnitude and can act as a trigger for conversion disorder and on the other hand neurologic symptoms may being referred to anesthesia side effects (regional, neuraxial and general) and mislead the true diagnosis and appropriate treatment. Patient Presentation: A 33 years old woman gave birth to a healthy and vigorous newborn by vaginal delivery under epidural analgesia. immediately after entering to the recovery unit the mother presented aphonia and motor function loss of the limbs while being conscious and oriented. The mother was not agitated due to her symptom and could fully understand conversations and answer our questions with head movements. Her symptoms went away within 2 hours of being under observe in the recovery unit and she got fully recovered and symptom free. After thorough assessment of the patient we were led to the diagnosis of conversion disorder which was proven correct after neurologic and psychiatric consultations. Conclusion: Although conversion disorder is diagnosed after having other possible diagnoses ruled out, it is important to consider conversion disorder as a possible diagnosis when we are facing neurologic symptoms inconsistent with clinical findings, especially in young women after a psychologic stressful situation like childbirth. considering the obstetric patients’ properties, we expect obstetric anesthesiologists to visit greater number of conversion patients in the perioperative time in comparison with other anesthesia fields.