JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2018 | Volume:40 | Issue:3 (103) |Papers Count:10

Background: Anesthesiology was emerged as a medical specialty from the early 20th century. Anesthesiologists manage vital procedures during surgery and induce anesthesia and, at the end of surgery, awaken patients. The people can be educated and their health can be improved by bewaring of their attitude and understanding of anesthesiologists and anesthesiology. So, this study is aimed to evaluate the knowledge of the general population about anesthesiology, anesthetic procedures, and the tasks of anesthesiologist and the factors influencing it. Materials and methods: This study is a descriptive-analytic cross-sectional study between 1396-97. The population of the study was healthy people in Tehran, Mazandaran, Khuzestan, Khorasan Razavi, Kerman provinces and Tehran city. The sampling method was defined in three levels: cluster sampling, stratified sampling, and simple random sampling. The data collection tool was a questionnaire. Data were analyzed using descriptive and analytical statistics and analyzed using SPSS v. 19 software. Results: 1558 questionnaires were completed. 52. 4% of the subjects were females and 47. 6% were males. The mean age of the subjects was 43. 62 ± 14. 8 years. The majority of subjects were married (54. 7%), had high school education (33. 4%) and were employed (63. 3%). The result of this study showed that 44. 2% of people were afraid of anesthesia. There was a significant relationship between gender and fear of anesthesia and between age and fear of anesthesia and between education and fear of anesthesia. Only 30. 6% of the people knew that they are anesthetized by anesthesiologists. The majority of people (76. 4%) had a tendency to be visited by their anesthesiologist preoperatively. 37. 9% of people tended to have general anesthesia and women preferred general anesthesia more than men. The majority of subjects (53. 4%) believed that general anesthesia was less risky than spinal anesthesia and had no knowledge of the duration of education of anesthesiologist at the university. Only 30. 4% of the subjects have knowledge about the anesthesiologist role in controlling acute and chronic pain, 16. 1% of them have knowledge about the anesthesiologist role in emergency unit and 37. 4% of them have knowledge about the anesthesiologist role in intensive care unit. Conclusion: Despite the fact that the majority of people participating in our study were educated and lived in urban areas, public awareness of the role of anesthesiologists in Iran was poor. This knowledge is improved by more relationship between anesthesiologists and community and increasing media attention to anesthesia and anesthesiologists and the provision of radio and television programs about the role of anesthesiologists and will help to improve awareness and understanding of community members regarding anesthesia and the role of anesthesiologists.

Background and purposes. Anxiety and fear a challenge in the care of ill health before surgery. More patients who are waiting for elective surgery, anxiety virgin and as a reaction occurs as expected. Can lead to an increase in anxiety before surgery, postoperative pain, longer hospital stays, reduce side effects at the time of surgery and patient satisfaction. Materials and methods. In this study, 140 patients and 140 patients, who were hospitalized for orthopedic surgery, were studied. Patients undergoing surgery due to trauma or elective surgeries were selected by the surgeon after the operation was respected in the list. By the person running the scheme by filling out a questionnaire designed for this purpose the information was collected. Data collection was performed preoperatively and on. Fill out the questionnaire were performed before treatment team. Results: The results showed that the mean age of participants was 43 years. Among the patients, 10% were illiterate, 67. 9 percent of patient’ s diploma or less education and, finally, 22. 1% of patients had an academic degree. 60% of patients had a history of previous surgery. The most common causes patients' anxiety before surgery afraid of inactivity after surgery, postoperative pain and eventually had surgery. While the companions of patients most common causes of anxiety, helplessness and anxiety after surgery on the patient. Also, several fields are fewer women than men experience anxiety. Conclusion: The overall results showed that anxiety is the most common cause of severe disability caused by inactivity and anxiety of patients and is associated.

Background: Cholecystectomy is considered as the most important and relatively common postoperative pain control often begins in recovery room by using systemic narcotics that may have some side effects. The aim of this study is to evaluate the effect of premedication with oral tizanidine on pain relief after elective laparoscopic cholecystectomy. Materials and Methods: In this double-blinded clinical trial, 60 adults of American Society of Anesthesiologist physiologic state 1 and 2 scheduled for elective laparoscopic cholecystectomy under general anesthesia were studied and randomly divided in two study and control groups. Ninety minutes before the induction of anesthesia, patients received either 6 mg tizanidine (study group) or placebo (control group) orally. Then, the vital signs, pain intensity, duration of stay in recovery, and the analgesic consumption were measured and then compared in both groups during 24 h postoperatively. Results: There was no significant difference in patient characteristics, with respect to age, weight, gender (P > 0. 05). The pain score were significantly lower in study group at recovery, 6, 12 and 24 hours after surgery (P=0. 01, P=0. 009, P=0, 005, P=0. 03). The need for analgesic drugs was significantly lower I tizanidine group. (485. 83 ± 52. 33 mg vs. 350. 87± 20. 86 mg), . There were no significant difference in hemodynamic parameters between two groups. Conclusion: Oral administration of 6 mg tizanidine before laparoscopic cholecystectomy reduces postoperative pain, opioid consumption.

Introduction: During cardiopulmonary bypass, oxidative stress happens in the patient's cells due to blood contact with various levels of synthetic materials. It can activate inflammatory process and release factors such as IL-6, CRP, and Neutrophils which may hurt different organs. In recent years, many efforts have been made to prevent this type of damage, however, no single treatment has been proposed to reduce this risk. Antioxidant substances such as Thiamine is important in cell defense against free oxygen radicals. Regarding this issue, in this study, the effect of thiamine on lactate levels in patients undergoing coronary artery bypass graft surgery has been investigated. Materials and methods: In this study, 140 patients from 25 to 65 years old with mild systolic dysfunction (EF = 45-55%) who were candidates for elective CABG surgery in two groups: control and purpose (patients receiving Thiamine) were examined. All of these patients were anesthetized in an identical manner, and were subjected to a heart-lung pump. Serum lactate levels were measured before, during and 6, 12, 18, and 24 hours after surgery. All data collected in a questionnaire were recorded and evaluated using spss statistical software. Results: Study groups showed no significant differences regarding demographics and underlying diseases. Serum lactate was significantly lower in thiamine group during the first 24 hours after surgery (except before operation and 2 hours later) (p <0. 05). Creatinine level in two groups before surgery was not significantly different, However, it was significantly lower in case group 24 hours after surgery (1. 54± 0. 14 vs. 1. 24± 0. 19; p: 0. 001). Also, dose of Inotropes in patients who received thiamine, was significantly lower than the control group (p= 0. 001). Exudation was longer in control group (15. 4± 4. 9 vs. 13. 15± 4. 1; p=0. 003) while ICU stay was not different. Conclusion: It seems that thiamine administration before cardiopulmonary bypass, in patient with decreased left ventricular function, can decrease serum lactate as tissue perfusion marker and also improve kidney function.

Introduction: Pain is one of the common complication of surgery. Pain is a complex of physiological responses to tissue injury. Patients worry mostly of how much pain they would experience after surgery. Dexmedetomidine and ketorolac are two drugs that have analgesic effects. The aim of this study is compare the preventive analgesia efficacy of Dexmedetomidine and ketorolac in patients after appendectomy operations Materials and methods: This study is a randomized double blinded clinical trial. Sixty patients aged 18 to 65 (ASA I-II) who had undergone appendectomy operations with general anesthesia were analyzed. The patients were divided into three groups according to the block randomization table. Group A patients received a bolus intravenous dose of 1 microgram/kg Dexmedetomidine in 10 minutes before induction and a continuous infusion of 0. 5 microgram/kg/hr during the operation. Group B received intravenous 30 mg ketorolac before induction. Group C was the control group that received normal saline. An intravenous infusion of normal saline was administered to groups B and C. Induction, maintenance and reversal were same for all study groups patients. At the end of anesthesia, a digital PCA pump containing fentanyl (bolus 10 microgram, lockout time 10 minutes) was applied. Pethidine (25 mg IV) was applied to patients who had intractable shivering. The patients’ vital signs were recorded 5 minutes after resting on the bed of the operating room, immediately after intubation, at 5, 10, 15, 20, 30, 40 and every 10 minutes till the end of operation. The patients’ vital signs, nausea – vomiting and the degree of shivering were all recorded. Pain intensity was recorded by VAS at 1, 3, 6, 12 and 24 hours after operation. In the case of a patient having a VAS greater than 3 and a request for analgesic medication a 100 mg diclofenac suppository was administered. The total volume of PCA consumed by the patients were recorded. The gathered data were statistically analyzed by an SPSS 19 software and P values less than 0. 05 were accepted significant. Results: there is no significant difference between the study groups regarding age, gender, height, weight, ASA classification, nausea-vomiting and shivering. The pain intensity was not significantly different betweem groups at 1, 3 and 6 hours after operation; but in the Dexmedetomidine group it was less than the two other groups at 12 and 24 hours after operation (P12= 0. 004 & P24= 0. 003). There was no difference between the ketorolac and control group. The total dose of fentanyl PCA used was significantly less in the Dexmedetomidine group compared to the control group (PPCA= 0. 003). Body temperature was significantly higher before, during and after operation in the Dexmedetomidine group compared to the two other groups (PT= 0. 001). During operation the decrease in body temperature was significant in the ketorolac and control groups (PK= 0. 037 & PC=0. 001). the changes in blood pressure were not significantly 45 different between the three groups but there was a significant increase in mean arterial pressure (MAP) during the operation time. Heart rate before intubation, at 5, 20, 40 minutes and in the recovery was not significantly different. The heart rate at 10, 15 and 30th minutes was significantly lower in the Dexmedetomidine group compared to the control group (P10=0. 022 & P15=0. 010 & P30=0. 015) and immediately after intubation, 10th minute compared to the ketorolac group (PPO=0. 033 & P10=0. 024). There was no significant difference between the three groups regarding the changes in SpO2 levels at before, after intubation and at 10th minute after intubation. However, the SpO2 levels were significantly lower in the Dexmedetomidine group compared to the other groups at 5, 15, 30, 40th minutes and recovery time (P5=0. 045 & P15=0. 006 & P30=0. 003 & P40=0. 003 PR=0. 024). Although the SpO2 levels did not have any significant change during the time within each group. Conclusion: Dexmedetomidine as an agent for preventing pain after operation is mostly effective at 12 and 24 hours after operation which attenuated the need for analgesic medication postoperatively.

Objective: hypertension is one of the most popular in most countries. Probability of this disease increases whit age. Ocular complications are seen whit HTN which necessitate their referral to the ophthalmic centers. The geriatric patients having hypertension and need ophthalmic surgery are increasing. The aim of this study was to surgery the rate of awareness about the presence of hypertension and its regular treatment in hypertensive patients. Materials and methods: 300 hypertensive patients in ophthalmic surgical center were studied in preoperative anesthesia clinic. The rate of awareness, their responsible physician, residency, drugs and their name, regular use of drugs, relationship between awareness and age, sex, complications of the disease and admission due to HTN, the blood pressure was measured in clinic, ward and operating room. The data’ s were analyzed with spss ver. 17. Results: Lack of awareness about the disease was 25. 3% in patients. The BP in whom was elevated in clinic and ward also was high in operating room. Treatment had significant relation with sex, residency and awareness. Conclusion: The results of this study showed that the lack of awareness about having HTN was high (in 1/4 patients). It is important to let the people know more about their health and the need for treatment in high quality and to reduce the complications of the perioperative management of these patients could be done well and safe.

Introduction In patients with head traumatic who have a low level of consciousness and require mechanical ventilation، two airway moisturizing devices are used to warm and moisturizing the airway based on clinical conditions of the patient. The purpose of this study was to evaluate the effect of two airway humidifying systems on the number of respiratory head traumatic patients under invasive mechanical ventilation. Materials and methods In this randomized clinical trial، 50 patients were randomly divided into two intervention groups. Two heat exchangers and heat exchangers and a filtered moisture were used for each group for 30 minutes each. At the end of each period، using airway moisturizer، the patient's respiratory rate was recorded from the patient's mechanical ventilation device، the data were analyzed by SPSS25 software. Results There was a significant difference between the two groups of heat and moisture exchangers and the heat exchanger and the filter humidity in the first placement (P = 0. 049). There was no significant difference between the two heat and moisture exchange groups and the heat exchanger and the filter moisture content in the second placement (P = 0. 056). Comparing the successive use of both devices in the thermal moisture group was significant (P = 0. 013). Comparing the successive use of both devices in the heat exchange group and the filtered moisture was significant (P = 0. 037). Conclusion The use of a heat exchanger and a filtered moisture exchanger in the path of an aggressive mechanical ventilation flow in patients with head trauma leads to an increase in respiratory rate، which can be due to an increase in airway resistance and an increase in arterial blood carbon dioxide and dead body volume. It is recommended that this airway moisturizer be used with caution and according to the patient's clinical condition.

Hydatid cyst is one of the most important parasitic disorders which cause some health issues in many countries such as Iran. In this disease, humans are intermediate host who may be infected via consumption of infected vegetables (infected with diseased dog feces). This disease could involve different organs in human body which the most common organs are liver and lungs. Cyst rupture could cause anaphylactic reactions and even death. In this paper we report a case of liver cyst rupture during surgery which treated with epinephrine and venoclysis and continued to the ICU. Patient discharged from ICU to ward after two days. As an anesthesiologist we should be always vigilant and prepared to encounter such events and the required equipment for these kinds of events must be at hand in operating theatre.