JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2007 | Volume:29 | Issue:59|Papers Count:9

Background: To determine and incidence and presence of a relationship between predictors of microalbuminuria and duration of mechanical ventilation (MV) in a general intensive care unit (ICU) patients and to compare the prognostic significance of microalbuminuria with known indicators such as the Sequential Organ Failure Assessment (SOFA) score.Materials and Methods: This study was a prospective observational study. The setting of study was Al-Zahra Medical Center ICU. Admitted critically ill patients were categorized by duration of MV to the group A (£7 days) and group 8 (>7 days). Any intervention was none. We measured serial spot urine albumin- creatinine ratios (ACR) on admission to ICU. (ACR-1), at 24, 72, 120 hrs after it and on the day of beginning or discontinuation from MV (ACR-2 or ACR-3). SOFA score was calculated on data at the time of admission to the ICU (SOFA-1), and on the days of starting or disconnection from MV (SOFA-2 or SOFA-3).Results: Seventy percent of patients had microalbuminuria and 63.3% had an ACR ³ 100mg/g admission. ACR-1 [mean (SE)] in patients group A and 8 was 30 (6) and 63 (16) mg/g respectively (p=0.0002), ACR-2 was 40 (4) and 52 (8), respectively (p=0.007), ACR-3 was 30 (11) and 44 (11) respectively (p=0.023). For all patients, mean (SE) ACR-2 fell from 37 (4) to 34 (8) mg/g at T3 (p<0.01). At T3, the SOFA score, significantly decreased compared with T2 (p<0.01) and there was also significant difference in this variables between patients in group A and 8 (p<0.05). For all patients, more than seven days duration of MV was significantly associated with SOFA score, UMA level, and ACR ratio on T1, and T3 (p<0.05).Conclusion: 80th the ACR and the SOFA score can be used together in estimating the risk of prolonged MV, even on the first day of admission of critically ill patients. It is also concluded that maintaining the level of UMA or ACR in normal range could shorten the duration of MV.

Background: Intravenous regional anesthesia is a routinely used method for extremity injuries specially upper extremity. The usual technique of exanguination in this procedure is Esmarch bandage although its pressure over patient's wound may cause pain and discomfort. The aim of this study is to compare the efficacy of the Esmarch bandage with the other method of exanguination namely limb elevation in intravenous regional anesthesia.Materials and Methods: Seventy patients with soft tissue injuries of upper extremity, nominated for intravenous regional anesthesia, were randomly allocated into two groups of experiment and control. Upper extremity exanguination was performed by Esmarch bandage in the control group and limb elevation method in the experiment group. Pre- and intra-operation pain intensities were evaluated by verbal response scale. The intensity of pain and need for intravenous tranquilizing and analgesic medications were compared in both groups by the exact Fisher and Chi-squre tests.Results: There was no significant statistical difference between the pain intensity data of two groups either before or after starting the surgery. The need for intravenous supplemental drugs for pain relief was similar in both groups,Conclusion: The limb elevation technique, while producing less discomfort for patients, can be as effective as Esmarch bandage in limb exanguination during intravenous regional anesthesia.

Background: Target-controlled intravenous infusion (TCI) is a new delivery system of anesthetic drugs. The rational of TCI is based on the obtaining and control of a desired target concevtration in plasma or effect-site (biophase). Shuttler avd Col first described the use of TCI system in 1983. The technique allows obtaining more precise titration of anesthetic drug, proceeding by successive stages of concentration of anesthetic drugs. TCI provides better adjustment between concentrations of the anesthtic drug and clinically required effects, that is a major interest in anesthesia practice, particularly for induction and the predict the recovery of patients. In this study we compared the efficacy of TCI and more traditional manually controlled infusion (MCI) in tympanomastoidectomy surgeries in Kermanshah Imam Khomeini Hospital.Materials and Methods: 60 ASA I-II patients who were candidates for tympanomastoid surgeries enrolled in this clinical trial study after written inform consent. Exclusion criteria were any regular use or addiction to opium derivatives or sedatives, also any use of medication affecting the sympathic system excluded the case from entering to study. All of the cases were monitored by BIS and were unpremedicated. The data were analysed by independent t-test, leven and U Mann-Whitney. for analysis of qualitative variables X2 and exact fischer test were used. Meaningful level of all of the tests was 0.05%.Results: Infusion rate of propofol and remifentanil were lower in TCI group patients. There wasn't any significant difference of wake up time between two groups but patients discharged faster from recovery to the ward in TCI group patients (Aldrete score). The patients in TCI group showed more hemodynamic stability during induction and maintenance anesthesia. Costs of drugs used in anesthesia were more in MCI group patients and finally post operative nausea and vomiting incidence was lower in TCI group patients.Conclusion: Efficacy of TCI with propofol and remifentanil is better than manually controlled infusion especially in the selection of patients and plasmatic drug target is good.

Background: We evaluated efficacy of a single preoperative dose of oral vaproxen in reducing postoperative pain and analgesic requirement in patients undergoing upper etremity surgery under intavenous regional anesthesia (IVRA).Materials and Methods: Sixty healthy patients (ASA I-II) undergoing upper extremity surgery were randomly assigned into two groups. 90 minutes before operation, the treatment group (n=30) recieved enteric- coated tablet containing 500 mg of naproxen, and the control group (n=30) recieved placebo. IVRA was achieved using 3mg/kg lidocaine diluted with saline to a total volume of 40 ml. Visual analogue scale (VAS) score at 0, 1, 2, 6, 12, and 24 hr after surgery, time to first analgesic requirement, total analgesic consumption in the first 24hr after operation, and side effects were noted.Results: VAS scores were lower in group naproxen after torniquet release and in first 12hr after completion of surgery (p<0.05). First analgesic requirement time was longer in group naproxen than group placebo (p<0.01). Postoperative analgesic requirement were significantly smaller in group naproxen (p<0.01). Side effects were not seen in both groups.Conclusion: We conclude that a single preoperative dose of 500 mg naproxen is effective in reducing postoperative pain in upper extremity surgery under IVRA, in the immediate postoperative up to 12hrs after the completion of surgery.

Background: The sacroiliac joint is the greatest axial joint in human body. This joint have an important role in balance of the body. Mechanism of pain and dysfunction is axial pressure and sudden rotation of joint.Materials and Methods: In this study 81 patients (62% female and 38% male) reffered to a private pain clinic injected intra-articular steroid and bupivacaine. Response to injection evaluated one week and 3' months later. Pain scoring was done by Numerical Pain Score (NPS)Results: Excellent response (reduction of pain between 80-100%) was found in 27.2% patients and good response (reduction of pain between 50-80%) detected in 45.5% patients and moderate response (reduction of pain between 30-50%) was 15.1% and unresponse to injection (reduction of pain lesser than 30%) in 12.1% patients detected.Conclusion: In this study intra-articular injection of steroid and bupivacaine in significant percentage of patients with sacroiliac pain was effective.

Background: Fear of withdrawal syndrome, is a common reason for addicts to continue their addiction. Researchers have tried to find solutions. Anesthesia is the main part of UROD and propofol is a common hypnotic for UROD. However a drug of choice has not been found until now.Materials and Methods: 100 ASA Class I patients were chosen. Candidates allocated randomly into two groups in a controlled clinical trial. Premedication and induction of anesthesia were the same for the two groups. The case group received isoflorane 0.4-1% for maintenance of anesthesia, and the control group received propofol 80-150, mg/kg/min as the maintenance hypnotic.blood pressure, pulse rate and any arrythmia were recorded during the anesthesia. Also pain, nausea and vomiting were recorded in PACU for two hours.Results: There were no significant differences in mean age, sex, proprtions and mean weight between the two groups. There were no significant differences in blood pressure or pulse rate between the two groups during the anesthesia. There were no significant differences in rate nausea and vomiting and severity of pain between the two groups in PACU.Discussion and Conclusion: Isoflorane is an acceptable alternative for propofol in UROD. This research proves that isoflorane in comparison with propofol (golden standard) has the same efficacy in controlling hemodynamic during anesthesia and complications in PACU.

Background: The pulmonary function test (PFT) was described the first time by Hutchinson in 1846 and was used by Tifno 100 years later. The respiratory function of patients who undergo cardiac surgery is affected by such factors as sternotomy, release and ligation of the internal mammary artery, and mechanical ventilation. We sought to assess this impact on respiratory mechanics.Materials and Methods: This randomized, prospective study evaluated 110 patients who underwent elective coronary bypass graft surgery (CABG). The patient were trained for the PFT, and the test was performed once before surgery and subsequently one and three months postoperatively. The prospective PFT results of each patient were compared with the preoperative onehence obviating the need for matching. A t-test was employed to evaluate the results.Results: Our study population comprised 110 (75 men and 35 women) at a mean age of 58.14 kg. Cardiopulmonary bypass was performed in 108 patients, at an average time of 80.32 minutes. In all patients, in addition to the internal mammary artery, the saphenous vein was also used. The force expiratory volume in the first second, tidal volume, and vital capacity were assessed preoperatively and at one and three months postoperatively. Eighty-nine patients referred for the first follow-up visit and 29 patients referred for the second follow-up vist.Two patients died and were, therefore, excluded from the study. All the criteria of respiratory mechanics showed a considerable decrease one month after surgery compared with those before surgery. However, the criteria became closer to those before surgeries at the second follow-up visit. The changes were more significant in the male patients compared to the female ones.Discussiom: Our findings, in line with many other related studies, show that sternotomy and ligation of the internal mammary artery to not have long-term effects on respiratory function and mechanics.

Background: To investigate hospital aquired infection (HAI) as an independent risk factor for in-hospital mortality in patients undergoing heart surgeryMaterials and Methods: A retrospective study of 9804 patients who underwent heart surgery procedures, between March 1997 to September 2000 (Data from Mar. to Dec. 1998 was not available and omitted). The mean age was 47.3 years.Data also gathered and compared with infectious group of them at the same time. We study some epidemiological aspects of HAI with respect to other variable such as type of procedures.Results: The cumulative incidence of HAI was 4.65%.Causative agents were Gram negative bacteria (Klebsiella, E.Coli, Enterobacter), staphylococcus aureus and pseudomonas.Common sites of infection were wound, blood, respiratory tract, and urine. In pediatric age group: blood, respiratory tract, wound and urine was common. The case fatality rate of HAI was 19.1% which increased to 27.3% in pediatric age group. The mortality rate was 5.15 times higher in nosocomialy infected children than in uninfected children at the same time.Conclusion: Severe perioperative HAI is a principal factor in hospital morbidity and mortality especially during childhood. Major effort should be devoted to the prevention and control of severe nosocomial infections in heart surgery.

Background: The purpose is to present a case of unilateral pupillary dilatation and severe hypertension during general anesthesia for nasal surgery due to inappropriate use of topical phenylephrine. Unilateral pupillary dilatation during general anesthesia has sinister implications, which might prompt further investigations specially in the presence of severe hypertension. However, in patients undergoing nasal surgery, it might be caused by the local and systemic actions of phenylephrine applied intranasally.Materials and Methods: A 18 year old girl underwent general anesthetic for septoplasty and bilateral turbinectomy. She developed severe hypertension, ventricular tachycardia and unilateral pupillary dilatation after application of phenylephrine mesh into her nose. Surgery and anesthesia were stopped. Blood pressure was controlled with diazoxide and nitroglycerine administered intravenously. Thirty minutes later she bucked and coughed on the ETT and opened her eyes and fully awake. Her right pupil was dilated (8 mm diameter). Her left pupil was normal. No other abnormality was detected and her vision was grossly normal. Neurological examination did not show any other abnormality.Conclusion: Inappropriate use of topical phenyleprine during general anesthesia may cause unilateral pupillary dilatation, hypertention crisis and other associated complications. Attention of anesthesiologists to these side effects of topical vasoconstrictors and their appropriate management is very important.