JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2008 | Volume:30 | Issue:61|Papers Count:16

Background: Because of importance of resuscitation and rescuing the people, we planned this study to assess the influences of common protocols administration in survival and outcomes of patients undergoing Cardiopulmonary Resuscitation (CPR) in Sina Hospital, Tehran University of Medical Sciences. It was a before-after study. Before- group were the patients in first half of 1384. The second or After-group were patients undergoing CPR after interventions including organizing of educational classes, determination of group’s task work and common protocols (AHA 2005), administration of educational booklets. Outcomes were assessed in at least 3 days after CPR. Data collection was done using a questioner and analyzed by SPSS version 13 software. Materials and methods: In this study, we assessed 729 patients undergoing CPR in Sina Hospital in 2 groups. 117 patients (16%) were alive after 3 days, 38 people of them were in Before and 79 person in After groups. There were no differences in sex and age of patients between groups. Cardiovascular diseases were the most common in dead patients and cerebral diseases were the second. Results: Of 86 patients who died after rescuing of the first CPR, most of them had died on 4th 6 hr after first CPR. Morbidity in first day was more than 2nd and 3rd days after CPR. The most mortality in first CPRs was happened in emergency room, then in ICU. There was no difference in mortality of patients in work hours. Time intervals between CPR code notification and starting the cardiac massage, also arrival of anesthesiology or cardiac (or internal medicine) residents were better in second group. Total CPR success rate was 16% (117 people) which was better in second group. Discussion and Conclusion: These results could show efficacy of our interventions in improving the outcome and survival in CPRs. Based on this study, we can suggest that using common protocols based on new and scientific methods for all medical practitioners, can improve outcome and CPR success rate.

Background: Despite of improved outcomes after cardiac surgery with cardiopulmonary bypass (CPB), postoperative cognitive complication remains a common problem (30 to 79% of cases) that is related to increased morbidity and prolonged hospital stay. The effects of corticosteroids on CPB-associated brain damage have not been documented. The purpose of this study was to evaluate the effects of methylprednisolone (MP) on postoperative cognitive dysfunction in cardiac surgery with CPB. Materials and Methods: In a randomized double-blinded clinical trial study, 60 consecutive adult patients undergoing coronary artery bypass under CPB were enrolled in the study. They were randomly assigned to three groups: group A (n = 20) received 15 mg/kg MP by an intravenous infusion after induction of anesthesia and group B (n = 20) received 15 mg/kg intravenously, before the onset of CPB. Group C (n = 20) received placebo and was considered as control group. Mini Mental State Examination (MMSE) was used to screen patients for postoperative cognitive status (maximum score= 27). The MMSE was performed the day before surgery and one and two days later. SPSS software and appropriate tests including Q2 and ANOVA and Duncan tests were used to analyze the data. A p-value of less than 0.05 was considered as significant. Results: Among intraoperative variables, there were no significant differences among the three groups concerning the CPB duration and operation duration. MMSE scores were similar preoperatively in the three groups (24.3±2.4, 24.2±2.4, 24.3±2.8 respectively). The scores were significantly more (better) in the group A (24.6±2.3, 25.2±1.7) than the group B (21.6±3.1, 22.6±2.4) and the group C (21.5±3.1, 21.9±2.6) at the first and second postoperative days respectively. The length of postoperative ICU stay of the Group B and C patients was greater.Conclusion: Methylprednisolone is able to reliably and clinically improve postoperative cognitive dysfunction following cardiac surgery with cardiopulmonary bypass if used at the beginning of the surgery.

Background: Postoperative pulmonary complications are associated with relative morbidity and mortality. Ventilator associated pneumonia (VAP) is an special type of hospital acquaried pneumonia that occurs during 48 hrs after starting of mechanical ventilation. It has a great financial load to the health care systems. In order to the importance of this problem (cost), this study was done to evaluate the epidemiology and incidence of hospital acquired peneumonia in ICU admitted patients. Materials and methods: This was a cross-sectional study with descriptive and analytic features that was done in Sina Hospital ICU ward during 1384 to 1385. Information was collected by information sheat. The patients without pneumonia, other infections and negative blood culture entered the study. Cases were the patients that were undergone elective or emergency surgery and also under mechanical ventilation. Information’s were analysed by SPSS. (percentile description for the descriptive part and & 2 and T test for the analytic part.).Results: Patients average age was 57±3.1, 55 male (68%) and 25 female (32%). GCS average was 8, average APACHE score and GCS at the beginning of study, but significant difference was seen at the end of the study (p<0.05).Conclusion: The incidence of ventilation associated pneumonia in post operative patients was high and pays attention to this important matter, can decrease the risk of the disease.

Background: Pain control is an important aspect in postoperative care of patient undergoing surgical intervention. Systemic opioids are the cornerstone options for the control of postoperative pain. In this study we evaluated analgesic effect of tramadol, indomethacin and acetaminophen for reducing opioid usages and their side effect.Materials and Methods: This randomized clinical trial study was performed on 92 patients scheduled for CABG surgery. Patients were randomly divided into three groups: (A: Acetaminophen, B: Tramadol and C: Indomethacin). Patients were evaluated for pain scoring daily by numerical rating scale (NRS) in three location that including median sternotomy, chest tube insertion and back pain at costovertebral junction. Drug side effects (Nausea and bleeding) and additional required morphine were recorded.Results: Three groups were similar in age, sex, diabetes, LIMA harvesting and induction and maintenance of anesthesia. Back pain at costovertebral junction was the most painful area with maximum severity in group A (p-value » 0.013 first day, p-value » 0.001 second day and p-value » 0 third day). The addition of morphine for pain relief in first and second postoperative day was the most in group A and the least in group B (p-value » 0.004 and p-value » 0.003 respectively).There was no significant difference in pain intensity of median sternotomy and chest tube insertion chest pain between three groups (p-value > 0.05). There was no significant difference in vomiting and chest tube drainage between three groups (p-value >0.05).Conclusion: Based on results of this study the tramadol produced better postoperative pain relief with a decrease in morphine consumption to reduce adverse effects.

Background: Bispectral index (BIS) assesses depth of anesthesia. There are controversial reports about opioids, like remifentanil, effect on BIS. At this study, the effect of different doses of remifentanil, 0.1mg/kg/min (LD) and 0.2mg/kg/min (HD) on BIS were evaluated.Materials and Method: 54 patients, ASA Class 1 or 2, age 20-60 years old who were admitted for cataract surgery under general anesthesia were selected. Induction of anesthesia: sodium thiopental 5mg/kg, succinylcholin 2 mg/kg, lidocaine 1 mg/kg and fentanil 2mg/ kg. After tracheal intubations, cisatracuriom 0.15 mg/ kg, propofol 200mg/kg/min and remifentanil HD or LD, each for 10 minutes, with randomized sequences. 4 patients were excluded because they got hypertension or tachycardia more than %20 of baseline or physical movement under general anesthesia.BIS was recorded every one minute. Comparison of mean BIS values of the two groups was made by intra group t-test.Results: Mean BIS in LD group was 51.73±5.87 and in HD group was 45.22±5.2. P-value was <0.001, so the difference was significant.Conclusion: Remifentanil combined with propofol can change BIS, so we can use BIS as an monitoring of depth of anesthesia during general anesthesia with opioids base.

Background: While opioids provide excellent analgesia undesirable side effects such as respiratory depression, nausea and vomiting, constitute major limitation. As a result many surgical centers use NSAID as analgesia adjuvant. The aim of this study was to examine the efficacy of Naproxen in treatment of post operative pain after CABG.Materials and methods: This is a randomized double blinded clinical trial study which performs in Heshmat Hospital in Rasht. 64 patients scheduled for elective CABG surgery were enrolled in this study. Patients were divided into 2 groups postoperatively: Naproxen group (n=32) and placebo group (n=32).One dose of drugs (placebo or 500 mg naproxen) was given (rectal supp.) immediately before tracheal extubation and second dose 12 hr later. Post operative pain was assessed and recorded using VAS within 24 hr after tracheal extubation per 3 hr. Pain was treated with 2 mg morphine IV repeated every five minute until pain score was < 3. Mean morphine consumption in the 24 hr was reduced in naproxen group (2.11±2.4 mg) when compared with placebo group (15.16 ± 3mg). In this study the incidence of post operative nausea and vomiting was reduced in Naproxen group.Results: This study show: Naproxen is an effective drug for treatment of post operative pain after CABG and can reduce PONV incidence.

Background: The present study was designed to determine and compare the hemodynamic effects of two nondepolarizing neuromuscular blocking agents, atracurium and cisatracurium, in coronary artery bypass grafting surgery (CABG) during anesthetic induction and operating time.Materials and methods: This study was a randomized, prospective, double blinded, clinical trial. We studied the patients undergoing elective CABG. One hundred patients were randomly divided into two groups; atracurium (n=50) and cisatracurium (n=50). The patients were anesthetized using 100% oxygen, sufentanil, and ethomidate. Tracheal intubation was facilitated with atracurium, (0.6 mg/ Kg ) or cisatracurium, (0.2 mg/ Kg) injection over 45 sec. The systolic and diastolic blood pressure, mean arterial pressure, and heart rate were measured before anesthetic induction, during anesthesia, operating time, and finally before transfer the patients to the intensive care unite.Results: There were no significant differences between the groups with respect of age, sex, coexisting diseases, preoperative ejection fraction (EF), duration of surgery and cardiopulmonary bypass. There were no significant differences in hemodynamic values (systolic and diastolic blood pressure, mean arterial blood pressure and heart rate) at 11 stages of study among the two groups. There were no episodes of cutaneous flushing or hemodynamic changes requiring therapy during anesthetic induction in any patients of two groups. The cost of atracurium was significantly less.Conclusion: There is no evidence of a hemodynamic difference between these two neuromuscular blocking drugs. Atracurium and cisatracurium appear suitable for use in cardiac patients undergoing CABG. There is only some cost advantage of atracurium.

Background and Objective: After craniotomy, hypertension may result to intracerebral hemorrhage. The aim of this study was to assess the effects of local infiltration of scalp with bupivacaine plus epinephrine in the site of craniotomy on hemodynamic changes during and after surgery and to compare them with control group. Materials and methods: In a prospective randomized placebo controlled clinical trial, 34 adult patients with ASA physical status I or II, undergoing elective craniotomy were enrolled. After induction of general anesthesia, they were randomly assigned to bupivacaine (5 ml bupivacaine 0.25% plus epinephrine 1:200,000) or normal saline (5ml normal saline 0.25% plus epinephrine 1:200,000), according to scalp infiltration solution. Hemodynamic parameters including mean arterial pressure (MAP) and heart rate (HR) were measured before anesthesia induction (as base measure), during scalp infiltration, during skin closure, on admission to intensive care unit (ICU), and 1 hr after admission.Results: There were no significant differences regarding the mean of age and sex frequencies between groups. MAP and HR were comparable during first three measurements, but MAP was significantly lower in the bupivacaine group compared with saline group at 1 hr after ICU admission (respectively 97.3±8.5 vs. 102.8±6.6 mmHg, P=0.043). HR was significantly slower in the bupivacaine group at ICU admission and 1hr after admission in comparison with saline group (79.25±7.3 vs. 85.1±8.9 beat/min, P=0.044 and 83.3±5.4 vs. 88.2±5.1 beat/min P= 0.011).Conclusions: Scalp infiltration in the site of craniotomy with bupivacaine 0.25% plus epinephrine would significantly lower hemodynamic variables in postoperative period and its application in craniotomy surgeries is recommended.

Spinal anesthesia is one of the most commonly used kind of anesthesia all over the world. Although rare, paraplegia can happen as a complication following spinal anesthesia, specially when the patient has some underlying disease like a previously unrecognized spinal tumor.Our patient was a 47 year old male referred for osteosarcoma of the right knee (distal femur). The surgery was done under spinal anesthesia, after that the patient developed paraplegia.Neurologic examination was done and MRI revealed massive tumor metastasis to vertebral bodies that caused T11-T12 cord compression. The aim of this article is to describe one of the rare complications of spinal anesthesia and notify the importance of doing neurologic examination before and after each spinal anesthesia.