JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2009 | Volume:30 | Issue:63-64|Papers Count:12

Background: From the beginning of anesthesiology, there has been a need for monitoring especially monitoring of oxygenation, acid and base status. So, different devices have been made which one of the most useful methods is monitoring of arterial blood gas which is an invasive way and is not useful for all patients.According to its complications and being invasive, this method is limited to specific patients. So, we compared the acid and base status in arterial blood with veins of hand which is an easier method and has less complication.Materials and methods: 20 patients with ASA Class I and II were enrolled in this prospective study. 15 minutes after induction of anesthesia, we first took blood sample of radial artery and immediately after it, of hand vein and were sent to blood gas labs.Results: In this study, oxygen pressure (PO2), CO2 pressure (PCO2), oxygen saturation (SPO2) and pH had significant difference in arterial and venous blood (p<0.01). Mean base exceeds (BE) and bicarbonate (HCO3) didn t have significant difference in arterial and venous blood (P>0.05).Conclusion: According to significant difference in PO2, SPO2 and pH of arterial and venous blood, venous blood can’t be used as a reliable replacement for arterial blood to evaluate the oxygenation and acid- base status.

Background: Iran is a young country according to mean age of general population and loss of consciousness due to poisoning is one of the most common problems in emergency department but the prognosis is good if appropriate diagnosis and treatment are done. The present study was designed to determent etiologist of loss of consciousness in poisoned patients that admitted in poisoning ICU of Loghman Hospital from 23 Sep 2004 to 20 March 2005.Materials and methods: This descriptive study was performed on 263 poisoned patients in poisoning ICU of Loghman Hospital that had loss of consciousness with advanced grades (2, 3 or 4) and were 10 years old or more. A questionnaire carried out and age, sex, grading of loss of consciousness, etiology of loss of consciousness, etiology of exposure questionnaire filled clinically for all patients who met our inclusion criteria, then by SPSS program our data were computed and statistical analysis by Chi-square test was performed.Results: from 263 patients 59.7% were male and %40.3 females. The mean age was 30.2±11.9 years with range of 11 to 76 years and median age was 26 years.The most common age group was 21 to 30 years (%45.3). The most common etiologies of loss of consciousness were TCA (%26), opium and opioids (%18.6), benzodiazepines (%15.43), unknown etiology (%9.7) and organophoshates (%7.7) respectively.Accidental poisoning was %23.6 and deliberate self poisoning was %76.4 cause of admission. %81.4 of patients discharged and %18.6 died.Conclusion: The most common etiology of exposure was deliberately, and the most common groups of poisoned patients were young people. Coma followed by poisoning is usually treatable with a reliable management.

Background: The hospitalized patients in intensive care unit who are undergone by long-term supportive ventilation, will involve in lung anatomic and physiologic changes. These changes will appear as decreasing the effective pulmonary volumes because of assembling lung secretion and atelectasis that will decrease the alveolar and arterial blood gases interchanging, consequently. It s results are excessive pulmonary shunt and decreasing the ratio of ventilation to blood flow. There are some effective ways for preventing these problems such as some attempts like chest physiotherapy, tracheal tube replacement and exchange it, suctioning the endotracheal tube simply by tube and by using fiberoptic, so we did this survey to study the effects of two ways of suctioning in patients of intensive care unit who were ventilated mechanically.Materials and Methods: In this study we selected 45 patients as sampels who were hospitalized in intensive care unit of Taleghani hospital. These patients didn't have any underline disease and at least were undergone the mechanical ventilation for 48 hours. Then we divided them into two groups of 22 and 23 people and in a cross over way each group was suctioned by open method first, then in 24 hours, by using of fiberoptic method. We measured blood gases before and after suctioning from both 2 methods and recorded in a check list. Data were analyzed by using of descriptive statistical and T paired.Results: This study's data showed that artery oxygen pressure was 216 after open suction and 189.7 after close suction which their differences between these two was significant and also artery CO2 pressure after close suction (38.8) was prominently higher than its amount after open suction (35.9) (P=0.001). The average of airway resistance after open and close suctioning orderly were 25.4 and 24.7 that had significant difference (p=0.036).Data about average of lung compliance showed, this average after open suction was 45.9 and after close suction was 45.9 too, which were the same.Conclusion: In spite of several studies data which showed close suction is more effective from aspects of consuming the time, expenses and more influence on ventilation for mechanical ventilated patients and they represented that decreasing airway resistance and increasing lung compliance in this method is more effective but in our study, close suction just in decreasing the airway resistance significantly was more effective than open method so it is recommended to other colleagues to study more about these two methods.

Introduction: Like that seen in adults, under treatment of acute pain occurs in substantial percentage of children. Control of postoperative pain is important in the pediatric patients because poor pain control may result in increase morbidity or mortality. One of the most important and safe rote for postoperative pain control in pediatrics, is rectal administration of acetaminophen. The aim of this study was to compare the analgesic and side effects of rectal acetaminophen and intravenous pethidine.Materials and Methods: A randomized controlled trial was performed in 60 ASA I, pediatric patients (aged 1-10 years) candidate to minor abdominal surgery, under general anesthesia, given either acetaminophen 20mg/kg rectally after induction of general anesthesia, and intravenous pethidine 0.3 mg/kg at the end of operation.Analgesic efficacy was assessed using Faces Score. Extra pethidine was administered if Faces Score was > or = 3.Results: We analyzed data of all patients. There are no statistical differences regarding weight and age among two groups. Faces scores did not differ between acetaminophen and pethidine group at recovery room, 2 and 4 hour after operation (p>0.05). Mean pethidine requirement also did not differ among two groups (5.5±0.4 in acetaminophen group vs. 5.7±0.7 in pethidine group and p>0.05).Conclusion: Administration of 20 mg/kg of rectal acetaminophen has a clear analgesic effect in minor surgery in children if administered at the induction of anesthesia. Moreover, children with adequate analgesia with acetaminophen have less postoperative pain scores, and nausea and vomiting.

Background: Preoxygenation with 100% oxygen before rapid sequence induction in pediatrics is recommended because of low oxygen reserve and high oxygen consumption. The aim of this study was to compare four different preoxygenation techniques in pediatrics: the traditional technique of 1, 2, 3 and 4 minutes tidal volume breathing.Materials and methods: 60 infants were randomly allocated into four groups and preoxygentated in tidal volume in 4 different times (1, 2, 3 and 4 minutes).Oxygen saturation measured in room air before and after preoxygenation. Desaturation time to 98%, 95%, 92% and 90% were measured.Results: There was no significant difference between groups in sex, ASA class, mean age, heart rate and O2 saturation before and after preoxygenation (p<0.05).ANOVA test shows significant difference between 4 min and other groups in desaturation time to 98%, 95%, 92% and 90% (p<0.0001).Conclusion: As a result of low respiratory reserve and twice oxygen consumption in pediatrics 4 minutes preoxygenation should be considered in order to maximize time for intubation period.

Background and Aim: In multistudies, the use of ketamine for the preemptive analgesia in the management of postoperative pain is controversial. The purpose of our study was the clinical assessment of the efficacy of preincisional peritonsillar infiltration of two doses of ketamine on postoperative pain relief compared with preincisional peritonsillar infiltration of saline in children undergoing tonsillectomy.Materials and methods: Seventy-five ASA physical status I and II patients, aged 3 to 12 years, scheduled for tonsillectomy were enrolled in this randomized, doubleblind, placebo-controlled study. Patients were divided into three groups of 25 each and received a local peritonsillar infiltration of 0.9% saline (Group A), ketamine 0.5 mg/kg (Group B), or ketamine 1 mg/kg (Group C). All medications were 2 ml in volume which was applied 1 ml per tonsil 3 min prior to tonsillectomy.The Children's Hospital Eastern Ontario Pain Scale (CHEOPS) and Wilson sedation scale were used to evaluate pain levels and sedative condition, respectively.Results: Group A had significantly higher CHEOPS scores than group B and group C. Group B and group C had comparable scores, which were not statistically significant (p> 0.05). During 24 hours after surgery, sixteen patients in group A and no patients in groups B or C needed analgesics (p < 0.001).Conclusion: A 0.5 or 1 mg/kg dose of ketamine given at approximately 3 min before surgery by peritonsillar infiltration provides efficient pain relief without sideeffects in children undergoing tonsillectomy.

Background: Electroconvulsive therapy (ECT) is a therapeutic procedure in many of psychiatric disorders such as major depression, mania, acute schizophrenia resistant to medical therapy and many other disorders.For prevention of bone fractures and joint dislocations during tonic-colonic convulsion due to ECT succinylcholine should be used. Intraocular pressure (IOP) rise with succinylcholine as well as tonic-colonic convulsion, IOP decrease with propofol. There is not any paper about the effect of ECT with propofol and succinylcholine on the IOP.Materials and methods: 100 patients 20-40 years old ASA Class 1 or 2 without any ophthalmic disorders were enrolled. All of their medications were discontinued since 48 hours before ECT treatment. The baseline IOP values were determined after tetracaine eye drop application, and then the patients received intravenously atropine 0.5mg, propofol 0.75mg/kg, succinylcholine 1mg/kg with 1 minute intervals then electrical stimulation applied via a bi-frontal electrode.IOP values measured before any drug administration, before electrical application as well as 1, 5 and 10 minutes after termination of the convulsion.Results: The baseline IOP (14.81±3.6) decreased significantly (13.18±3.55) after propofol but increased significantly (15.52±3.58) after succinylcholine, the IOP also increased significantly1 minute after convulsion (18.32 ±3.49) and 5 minutes after convulsion (15.41±3.46), but it returned to the baseline10 minutes after convulsion (14.68 ±3.57).Conclusion: In conclusion, IOP increased after ECT but the IOP values never reached to pathologic zone at this study, so we regarding to IOP, ECT is a safe procedure in the normal eye patients. Further studies recommended in oldest patients with ophthalmic diseases or at the presents of antipsychotic drugs.

Background: Adequate preoperative evaluation with sufficient informed consent from patients will lead to safe perioperative anesthetic managements. Recently anesthesiologist- directed preoperative evaluation clinics are used to prepare patients for the administration of anesthesia and surgery. Studies have shown that these clinics can reduce preoperative testing and consults, but few studies have examined the impact of the clinic on case cancellations at the day of surgery.We tested the impact of the visit to an anesthesia preoperative evaluation clinic (APEC) on case cancellations at the day of surgery.Materials and Methods: In a retrospective observational study, we evaluated the chart of 5765 elective cases operated during one year (1385) after starting visit to an anesthesia preoperative evaluation clinic (APEC). They were compared with 6067 cases under the previous system (during 1384). We examined the patients and obtained informed consents. Additional examinations and medications were ordered if necessary for adequate preoperative management. The impact of a clinic visit on case cancellation and delay in both sites were analyzed separately and compared.Results: A total of 11832 cases were included. 949 of 5765 (16.46%) APEC-evaluated patients were cancelled, as compared with 1325 of 6067 (21.83%) patients without a clinic visit (P=0.000). In APEC evaluated patients, cancellation due to "need for additional examinations and medications" significantly reduced. (20.3% in compare with 28% in non evaluated patients (p=0.000).Conclusions: An evaluation in the APMC can significantly reduce case cancellations and delays on the day of surgery and improve the quality control of patients before surgery.

Cauda equina syndrome is a sign and symptom of end tail spinal cord damage. Urinary retention and fecal incontinency, the results of sacral roots injury; are its complains. Mechanical (spinal cord trauma and chemical agents (intrathecal drugs) are the most important causes. In this article, a patient whom involved after spinal anesthesia is reported.A 46 -year -old woman underwent spinal anesthesia with 3.5 ml marcaine 0.5% for right hip bipolar arthroplasty. She had a past medical history of head trauma and seizure in childhood that controlled with phenobarbital and carbamazepine, partially. The spinal anesthesia technique was done correctly and a desirable anesthesia achieved until the end of surgery. Then she was involved with urinary retention and fecal incontinency after surgery. Lumbosacral and brain magnetic resonance imaging was normal but the electromyogram and neuron physiologic study of anus showed bilateral severe axonotometic damage from S-2 till L-5 roots. Her diagnosis was Cauda equina syndrome.Defecation control was recovered after 45 days and bladder function was cured after 55 days, fortunately.This syndrome is a very rarely complication of local anesthetics because they are neurotxic agents. The neurotoxicity of local anesthetics was established in animals and in-vitro studies, previously. While in other reports the neurotoxicity of lidocaine is more than bupivacaine. The rate of neurologic damage in spinal anesthesia is more reported than epidural anesthesia.The anesthetist must be consider the etiology of prolonged impairment sensation, paralysis and or sphincter function after spinal anesthesia (such as hematoma, abscess, epidural tumor herniation or drug side effect); diagnosis maters (history, physical examination, imaging, neurophysiologic study etc.) and treatment.