JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2015 | Volume:37 | Issue:1 (89)|Papers Count:12

Introduction: Sore throat is common complication after general anesthesia. The aim of this study was the effect of beclomethasone spray and fluticasone spray on reduction of sore throat and pain intensity of sore throat after general anesthesia.Materials and methods: In this double blinded clinical trial study, 90 patients candidate for general anesthesia were selected and divided randomly in three groups. In one group endotracheal tubecuff which impregnated with 200 mg fluticasone spray, another group with 200 mg beclomethasone spray and control group with normal saline.1 hour and 24 hours after anesthesia, patients of groups followed for sore throat. Ultimately informations were analyzed statistically with kruskal-wallis and chisquare test.Results: During 1 hour and 24 hours after operation, frequency of sore throat of patients in fluticasone spray group and beclomethasone spray is less than control group. Also, intensity of sore throat in fluticasone spray group and beclomethasone spray is less than control group, But there was no significant statistical difference between three groups (p>0.05) Conclusion: Using beclomethasone spray and fluticasone spray on endotracheal tube cuff have no significant effects on reduction of sore throat and intensity of sore throat after general anesthesia.

Introduction: Endotrachial suction is a metod to remove secretions from the airway in patients who can not perform this voluntarily and have an artificial airway. Suctioning is frequently used in the ICU and can result in many complications if not performed properly.The aim of this study was to evaluate nurses performans on standardized endotracheal tracheostomy tube suctioning in intensive care unit.Materials and methods: In this profile Descriptive study the performance of 136 nurses occupied in ICU section on tracheostomy and endotracheal suction was considered.the finding data were acquired through using a checklist containing 25 items. They were analysed by central index, t. test, k2 test and spss 21.Results: The result showed that the performance of 19.2 percent of subjects were weak, 65.4 percent moderate and 15.4 percent were good. On the other hand none of the subjects showed excellent or bad performance. More over the noticeable statistical differences did not observe between the average of subjects, performance in tracheostomy and endotracheal suction. (p>0.05). Also while some factors as age, education and having experience in occupied business had direct offection on subjects, performance (p<0.05), other factors as age, gender had no effect (p>0.05).Conclusions: Although based on the finding data the subjects, performance on tracheostomy and endo tracheal suction was rather desirable. It seems that doing more researches in this case in necessary because in this research some factors related to the standards of tracheostomy and endotracheal suction were ignored.

Background: There is still insufficient evidence to warrant the routine use of Bispectral Index (BIS) in the intensive care unit. One way of evaluating the usefulness of BIS in monitoring the level of consciousness in ICU patients is demonstration its degree of correlation to commonly used scales of prognosis. The aim of this study is to Compare BIS with APACHE II and SOFA Score in Intubated Patients with Different Pathologic Injuries of the Brain Due to Acute Head Trauma Admitted to the ICU.Materials and methods: 30 intubated head trauma patients over 15 years old admitted to the ICU were included in this cross-sectional study. In the first three days of admission, each patient underwent monitoring of BIS every sixty minutes just for six hours a day. All the hypnotic drugs were discontinued six hours before starting of monitoring and only opioids (fentanyl) were administered if needed. APACHE II in the first day of admission, SOFA Score in the first three days, type of cranial injury, and laboratory data were all collected. Statistical analyses were used to evaluate the data. P<0.05 was assumed statistically significant.Results: APACHE II and SOFA Score, had no statistically significat correlations with mean BIS in each three days of study and the mean BIS total.Mean BIS in the second and third days had statistically significant differences in different types of cranial lesions (contusion, subdural hemorrhage, subarachnoid hemorrhage).Conclusion: In acute head trauma patients BIS has not acceptable conformity with APACHE II and SOFA Score. Different kinds of acute traumatic cranial lesions with different prognosis may have different values in BIS monitoring.

Introduction: Physical restraints are commonly used in different hospital wards especially at ICU to ensure of patient safety and management of patient agitation and perevention of dislodgement of medical equipments connected to patient.Objective: To examine the effectiveness of education on trauma critical care staffs knowledges and practices about application of physical restraint.Materials and methods: This study is a quasiexperimental design that conduct on trauma critical care staffs in kerman at 2014. Staffs were randomly assigned in two control and intervention groups and each group included 35 persons. The questionnaire included demographic data and two scales for examine staff knowledge and practice about physical restraint. These scales was completed by all of the participants. Then an education program conduct for intervention group and after 2 weeks, twice that scales completed by intervention group.Data was analyzed by SPSS 18 and paired t-test, independent t-test, Anova and pyerson correlation.Results: Results showed a significant improvement in the intervention group in terms of knowledge (p<0.001) and practice (p<0.001) related to physical restraints after education program completion.Conclusion: Findings indicated the level of staffs’knowledge and practice that demonstrated the need to provide an education program on physical restraint use and these programs can significantly improve the staff knowledge and practice.

Introduction: The SOFA scoring system is one of the most validated and prevalent general scoring systems over the world. The number of studies in this field is limited in our country. The aim of the current study was evaluation of SOFA among adult Intensive Care Unit’s patients in Bojnourd.Material and methods: This prospective Cohort study included 300 consecutive patients admitted to surgical and medical ICUS. SOFA score and demographic characteristics were recorded for each patient separately. Logistic regression, Hosmer-Lemeshow test and the area under receiver operating characteristic (ROC) were used in statistical analysis (95% confidence interval).Results: Data analysis showed a significant statistical difference in SOFA score between survivors and Non-susrvivors (p=0.001). The discrimination power for SOFAwas poor (area under ROC (AUC) curve: 63.4±0.036) and Calibration was acceptable (x2=11.018, p=0.051).Conclusions: SOFA showed good predictive accuracy for results in surgical and medical ICUs.However, because of being simpler and easier to record data, it may be the choice to select.

Introduction: Sleep is a basic need for recovery and survival of cardiac patients who are admitted to intensive care. Sleep disorder in them may cause physiological changes during sleep and negative effects on the health of patients. This study aimed to evaluate sleep disturbances in patients with acute coronary syndrome in cardiac care unit by using specific questionnaire.Materials and methods: In a descriptive study of 220 patients with acute coronary syndrome admitted to the cardiac care unit of Imam Ali Hospital in Kermanshah in 1391 were selected through random allocation sampling. Data collection tool in this study was a two-part questionnaire containing 25 questions that the its validity and reliability had been confirmed. Data by using SPSS v.20 software and descriptive were analyzed.Results: In total 81% of patients reported some degree of sleep disruption. In 50.9% of patient poor sleep disorders39.5% moderate sleep disturbance and 0.5% of cases, severe sleep disturbance was observed and no abnormalities were observed in 9% of cases. Of the six dimensions of questionergreatest problem were observed in the disturbance of onset and maintenance of sleep (16.4±5.5. ( Discussion & Conclusion: Given to the high prevalence sleep disturbances in patients with CAD in the this study, Complete and comprehensive Evaluation of the patient and develop a care plan and nursing interventions is essential to improve the patient's sleep.

Introduction: Routine medical tests does not have any benefits on postoperative complications and treatment of patients with low risk surgery like cataract. Anesthesiologist management of preoprative unnecessary routine tests, can be effective in reducing patient anxiety and costs and also reducing the possibility of postponement of operation. The purpose of this study was to evaluate the effect of routine preoperative tests in the treatment process and hospital costs of cataract surgery as a low-risk surgery.Materials and methods: One hundred and fifty patients, aged 50-85 years with ASA class I-III that scheduled for elective cataract surgery were enrolled to this descriptive study. Results of history and physical examination as well as tests were recorded on special forms in operating room. Any changes in the treatment process and also the operating and recovery room complications were recorded.Results: In total, 70.2% of tests were unnecessary and 6% added to the patient’s hospital costs.14.6% of patients had abnormal tests with 0.7% changes in the treatment process. None of the patients had any complications during the surgery and recovery course.Conclution: Unnecessary investigations and tests are common before cataract surgery but had no significant effect on treatment process. This confirms the importance of the anesthesiologist's preoperative visit.

Introduction: Finding effects of spinal and/or general anesthesia on Apgar score of neonates being born after caesarian section.Materials and Methods: After designing the study and green light from “Sarem Research Center”, 259 ASA I and ASA II women who were going to have caesarian section in operating room or labor room of the hospital were selected through consecutive sampling. Sample gathering went from June 2013 through February 2013 (9 months). Women were subjected to the same spinal and or general anesthesia method performed by a single operator after obtaining written consent. All women were monitored according to standard monitoring guidelines throughout anesthesia and surgery. The Apgar score for each baby was evaluated by the pediatrician and recorded for the first and fifth minutes after birth. All obtained information was entered into study form and then analyzed by IBM SPSS statistical software version 20.Results: Neonates’ first minute Apgar score in spinal group (8.51±0.95) was significantly different from first minute Apgar score in general group (7.56±1.832) (p<0.05). There was also a significant difference between fifth minute Apgar score of neonates in spinal group (9.7±0.596) versus general group (9.15±1.343) (p<0.05). There was no significant difference between two groups in order of days of hospitalization in the NICU; (0.84±1.813) in spinal group versus (1.45±3.059) in general group (F=3.463 Sig=0.064).There was a significant difference in pre and post anesthesia systolic and diastolic blood pressure between groups (Table 5).Conclusion: Small but significant differences in first and fifth minutes Apgar scores of neonates born through caesarian delivery by spinal or general anesthesia methods has no statistically significant effect on days of hospitalization of neonates in the NICU and/or neonates’ survival.

Introduction: Malignant hyperthermia is one of the contraindications to use succinylcoline and volatile inhalation anesthesia drugs also is a pharmacogenic disorder and life threat event. Clinical presentation mostly followed by hypermetabolism, rigidity of muscles and hyperthermia. The aim is presentation of a suspected case of malignant hyperthermia following isoflurane.Patient presentation: The patient was 18 years of age and 60kg candidate of uretroscopy. Patient and his family did not report history of neuromuscular disease. The patient had not experienced anesthesia .Induction started by propofol and maintenance continued by O2, N2O, propofol and isoflurane. At the end of surgery muscles of patient was rigid in the recovery. Core temp increased rapidly and did 41°c.Also acid-base disorder, tachycardia, tachypenea, increased ETCO2 were manifestations of malignant hyperthermia. Treatment comprised of dontrolene and supportive cure.Conclusion: Although muscle biopsy is diagnostic, however, treatment should be started with dantrolene and supportive care following manifestations to decrease complications. Recurrence of symptoms can occur up to 36 hours without any stimulas.