JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2007 | Volume:29 | Issue:60|Papers Count:11

Background: Acid base disturbances are a very important issue in ill patients. There are three different approaches to this problems:Henderson - Hesselbach, Anion Gap and Srong ion difference.In this study we tried to compare these methods in individual patients.Materials and methods: This prospective observational study, has been conducted on 178 patients admitted in Masih Daneshvari Hospital ICU. We extracted arterial samples from all cases and interpret them by three approaches.Anion Gap and SID were calculated by the following equations: Ag= (Na++K+) - (Cl-+HCO3) SID apparent=Na++K-+Ca2++Mg2+- (Cl-+lactate).Results: Alkaloids was the most common disturbance in different approaches. The most common problem in SID approach was hypoalbominemia alkalosis.Conclusion: Different approaches were compatible (Kappa=0.163).

Background: Today, propofol is the most commonly used drug for induction of anesthesia. With the induction dose of propofol, hemodynamic changes such as decreases in systolic and diastolic blood pressure and heart rate can occur. Pain on injection is another side effect of this drug. Many methods have been used for reduction of this pain. The purpose of this study was to evaluate hemodynamic changes and pain reduction of two small doses of ephedeine (30, mg/kg and 70, mg/kg) after induction dose of propofol compared with lidocaine and placebo.Materials and methods: 100 patients aging 19-49 year ASA 1, 2 scheduled for electiv surgery under general anesthesia were entered in a prospective double blinded randomized clinical trial. All patients' were visited in wards the day before operation and visual analog scale (VAS) for pain was explained to them. In the operating room, pulseoximetry, ECG monitoring and non invasive blood pressure monitoring (NIBP) were established. Patients were randomly allocated into 4 groups, each group including 25 patients. Patients received 2 ml normal saline as placebo in group A, 2ml 2% lidocaine in group B, 30, mg/kg ephedrine in group C and 70, mg/kg ephedrine in group D. After 30 sec propofol 2.5 mg/kg was infused through the same line with an infusion rate of 1mils. A blinded anesthesiologist asked the patient to evaluate VAS every 5 sec. The maximum pain score was recorded. BP and HR were measured before and after induction and 1, 3, 5 minutes after intubation.Results: There were no demographic differences such as age and gender between the groups. Systolic, diastolic and mean arterial pressure (MAP) and HR after induction in group C and 0 were higher than group A and B respectively (p<0.05). There were no differences in systolic, diastolic and mean arterial pressure and HR 1, 3, 5 min after intubation in 4 groups. Lidocaine and two doses of ephedrine reduce the pain on injection of propofol with the same value (p<0.05).Discussion: Compared with placebo, lidocaine and the two doses of ephedrine reduce the intensity of pain on injection of propofol. Small doses of ephedrine attenuate BP and HR reduction after induction of anesthesia with propofol.

Background: End-tidal CO2 has a linear correlation with arterial pressure of CO2 in adults. Such relationship in critically ill pediatric patients is conflicting. We have studied this correlation in intubated patients of Mofid Pediatric Hospital, Tehran, Iran.Materials and methods: From 38 mechanically ventilated critically ill, intubated patients 68 pair samples of PaCO2- PETCP2 were gathered. We used side stream capnograph before arterial sampling. This study were conducted from March 2006 until October 2007 in pediatric intensive care unit of Mofid Hospital.Results: Patients were 2.2±3 year old and 56% of them were girls. They were admitted due to neurologic, respiratory, hematology, cardiology or other causes. PETCO2 showed a strong correlation with PaCO2. Linear regression analysis depicted following outcome: PETCO2=0.7 PaCO2 (95% confidence interval: 0.56-0.79) +3.7 (95% confidence interval: 0.5-7.9) Those patients with a better respiratory condition (SpO2>85%) had a PaCO2 - PETCO2 difference of 4±2 while in poor circumstances (SpO2<85%) this figure was 11±7.Conclusion: We recommende using capnograph for monitoring ventilation of intubated pediatric patients in intensive care units. Estimation of arterial CO2 pressure according to end-tidal CO2 depends on the pulmonary function. As the respiratory condition deteriorates PaCO2-PETCO2 difference enlarges but the linear correlation remains.

Background: Ability to estimate the mortality risk, in costing setting like ICU is of great importance, to evaluate new treatments, resource consumption control and improve quality control. Acute physiology and chronic health evaluation system (APACHE) is developed to predict critical care outcomes. In this system, according to the setting, a score is considered for each patients and then using an equation, predicted mortality risk for each patient is estimated. In order to estimating the predicted mortality risk in BooAli Hospital ICU admitted patients and comparison with actual death rate and estimation of association of mortality with age, sex and APACHE III score, we started the trial.Materials and methods: In a prospective analytic trial, we observed 269 ICU patients in BooAli Hospital, Tehran, Iran, over 10 months. We calculate APACHE III scores for each patients and obtaind, predicted mortality risk (using APACHE III-J software). Accuracy of the results were done with regression analysis and were compared with two American and Japanies same studies.Results: 51.7% of patients were female and 43.3% were male. Patients average age was 61.5 year. APACHE III average score was 60.6. Predicted mortality risk was 25.6% and actual death rate was 27.1% and finally SMR (actual death rate to predicted mortality risk ratio) was found 1.05 in this study.Conclusion: there were relationship between actual death rate and APACHE III score and patients age (p= 0.0001), but no significant relationship between sex and death rate were found (p=0.31).SMR=1.5 in our study represents direct linear association between predicted and actual death rate (p=0.0001).

Background: Propofol as a new intravenous hypnotic drug in combination with a short acting opioid have been used in total intravenous anesthesia (TIVA). The BIS provides additional information for standard monitoring techniques that helps guiding administration of hypnotic agents.Objective: The comparison of different propofol dose for anesthesia induction based on BIS (bispectoral index) monitoringMaterials and methods: Forty five patients with ASA I, II undergoing by fracture surgery were randomly assigned to 3 groups. Group A with a propofol dose of 1 mg/kg. Group B at a dose of 1.5 mg/kg and group C at a dose of 2 mg/kg were studied. Remifentanyl 0.5 mg/kg was added to propofol as opioid drug. The method of BIS index (50-60) has been used for determination of consciousness level and the depth of sleep for achieving the appropriate dose of propofol. The patients were evaluated to determine concerning the increased HR, occurence of hypotension, bradycardia and the presence of movement duruing intubation as well as the autonomic signs.Results: The mean levels of BIS were 58.8±9.85 in the group A, 50.2±6.55 in group Band 44±5.65 in group C. A comparison between the mean levels of BIS revealed that the group A was significantly different with the other two groups (p=0.009). Optimum level of BIS were significantly different in all 3 groups. Group B: 66.7%, group A: 40%, group C: 20% (less than of all groups) (p=0.034). Hypertension following intubation has seen in 33.3% group A (greatest level) and in 6.7% of group B, and in C group, no hypertension detected that was significantly different (p=0.018). Regarding the need for propofol repeated dose, there was a significant difference in group A, there was a need for propofol repeat 40% of cases, and in groups Band C, was not obsereved (p<0.001). Tachycardia, bradycardia, hypotension, movement and autonomic signs, had no significantly differences between 3 groups.Conclusion: It was appeared that group A is not appropriate due to incompatible with BIS, and the need for repeated propofol dose and hypertension. Considering the best BIS level in group B and lack of any benefit in group C for propofol repeated in achieving the optimum level of BIS (50-60), it can be concluded that group B with propofol 1.5 mg/kg is the best dose for achieving the desired level of BIS with remifentanyl at the mentioned dose.

Background: In pediatric dentistry successful treatment dependants on behavior control of children. There are several methods of drug administration such as intramuscular, inhalation, and oral for behavior control during dental work. Oral sedation is easy for use and has good acceptance for children. Oral midazolam has good absorbtion, predicable effects and little complication in oral sedation in pediatric dentistry. In this study we evaluated 0.5 mg/kg oral midazolam for behavior control of children in pediatric dentistry.Materials and methods: In this study we adminis-trated 0.5 mg/kg midazolam in orange juice to 36 non cooperative 3-5 years children. After 20 minutes children separated from parents and sat down on dental chair. Drug acception, cry during separation from parents, crying during injection and work, sedation and working condition according to Houpt scale were evaluated and recorded. Data analyzed with SPSS software.Results: In this study 36 children with average 4.44 years old were studied. 77.8% of them were quite during separation from parents. 55.6% and 77.8% of them during injection and treatment didn't cry. Also 61.1% and 88.9% of them during injection and treatment were sleepy. 38.9% and 72.2% of children during injection and treatment didn't have any movement.Discussion: Results of this study showed that oral sedation with midazolam has good efficacy in sedation and movement control in children during dental treatments, and dentists can work in quiet environment and better condition for children under sedation with oral midazolam. Also tolerance of dental treatment in children is better.

Background: Postoperative nausea and vomiting (PONV) are potentially serious complications of surgery. In this study we compared the effect of tropisteron, dexamethasone and metoclopramide in prevention of PONV after cataract surgery.Materials and methods: In this study, 60 patients (age range of 25-85 years and ASA I, 2) candidate for cataract surgery were divided randomly into 3 groups. After similar general anesthesia technique, the first group was administered IV 2 mg of tropisteron, immediately after surgery, the second group was administered dexamethasone 0.15 mg/kg (maximum 8 mg IV) immediately before commencement of surgery and the third group was administerd metoclopramide 0.3 mg/kg (maximum 10 mg IV) immediately after surgery. PONV were assessed in all patients after surgery, during two phases: the early phase (0-6 hrs) and the late phase (6-24 hrs).Results: The result of this study showed that metoclopramide and tropisteron were effective in preventing PONV during its early as well as the late phases, while dexamethasone was only effective in the late phase of PONV.Conclusion: The finding of this study suggest that metoclopramide is a suitable drug in preventing PONV during both early and late phases of cataract surgery, and because of its cheap and wide availability, it is recommended as antiemetic drug for this type of surgery.

Background: Opium derived from poppy that contains twenty types of alkaloids for example: morphine and codeine.Basic alkaloid of opium is morphine with concentration about 10% cardiac effects of opioids assump be positive inotropic or negative inotropic (except morphine) chronic effect of inhalation or oral opium on cardiac function and prevalence of myocardial infarction and amount of coronary artery disease and relation between incidence and age evaluate in this study.Materials and methods: 50 opium cosumptive person and 50 non-opium consumptive person in separated groups that scheduled for coronary artery bypass grafting. After completion of information, data was analyzed by student t-test and Q-square for quantitative data.Results: 100 patients included in analysis. 56% of addicted patients had abnormal ejection fraction (EF<40) versus 36% of non - addicted patients and 56% of addicted patients had high left ventricular end diastolic pressure (LVEDP>18) versus of 27% of non -addicted patients.Conclusion: This study shows that addicted patients have higher LVEDP and lower EF versus non-addicted patients. Thus opium does not prevent myocardial infarction against other studies.

Tracheal stenosis is extremly rare in pregnancy and frequently mistaken for and treated as asthma. We describe anesthesia management in a pregnant patient with severe subglotic stenosis who required rigid bronchoscopy for dilation and laser treatment of stenotic area.