JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2019 | Volume:40 | Issue:4 (104) |Papers Count:11

Background and Objectives: Estimating intraoperative blood loss is an important task for fluid resuscitation of patients during operations. In this regard we conducted a prospective experimental study to evaluate the accuracy of visual estimation of blood loss during caesarian section by operating room staff and physicians and evaluate the effect of their personal experience and education on this estimation. Our secondary end point was the effect of education on this estimation. Materials and methods: A clinical scenarios were reproduced in the form of 4 stations augmented with known volumes of expired packed cell on gaz, longaz, receiver and the earth surface. Fifty one staff estimated the blood loss visually and recorded their results, profession and experiments in two separate session before and one week after education. Recorded data were compared between two sessions. Results: Of total 51 participants, 30(59%) were physician and 21(41%) were technician. Mean visual estimation of blood loss was 421. 5± 43. 5 and 414. 5± 16. 5 ml before and after education respectively (P=0. 051, 95% CI). Mean difference between estimated blood loss and actual blood loss at first time was 76. 5 ml and at second time was 106. 4 ml respectively (P=0. 001, CI 95%). Median percent error in estimated blood loss was not influenced by clinical experience, either before or after the didactic session. Blood loss tends to be overestimated both before and after didactic session (P> 0. 050). Conclusion: Accuracy of visual blood loss estimation was not different between participants and also was not affected by clinical experience and profession either before or after the didactic session.

Background: Determination of contributing factors of hemodynamic alterations during child delivery is important. One of the factors is brief extra-abdominal uterine fundal pressure during cesarean section to facilitate delivery. Hence in this study the maternal hemodynamic effects due to brief extra-abdominal uterine fundal pressure during cesarean section were assessed. Materials and methods: In this interventional quasi-experimental study, 117 consecutive pregnant women undergoing cesarean section in a training hospital in Tehran in 2018 were enrolled. The brief extra-abdominal uterine fundal pressure was done and blood pressure and heart rate were determined and compared before and after the pressure. Results: After brief extra-abdominal uterine fundal pressure the heart rate and blood pressure were significantly decreased (P=0. 001). The maximal decrease was 40 mmHg, 10 mmHg, and 28 beats for systolic blood pressure, diastolic, blood pressure, and heart rate, respectively. Conclusions: According to the obtained results, it may be concluded that there are hemodynamic effects due to brief extra-abdominal uterine fundal pressure during cesarean section and attention to these alterations and prevention of potential adverse effects is recommended.

Introduction: General anesthesia and intratracheal intubation has a common complications such as hoarseness and sore throat, which are more severe in patients with difficult intubation. Therefore, the researchers decided to investigate the anti-inflammatory effects of rosemary extract on hoarseness and sore throat after intratracheal intubation. Materials and methods: The study was a clinical trial, 70 patients were randomly assigned to intervention (sterile gauze impregnated with rosemary extract) and control (sterile gauze impregnated with normal saline) groups. The sore throat and hoarseness status were measured by VAS and the data were statistically analyzed using Fisher’ s exact test in SPSS-20. Results: The incidence of sore throat in the intervention group and the control group was 49. 77± 4. 77 and 53. 20± 4. 93, respectively. This indicated no significant difference between the two groups (p=0. 6). Discussion and Conclusion: Anti-inflammatory properties of rosemary extract have been proven in previous studies. However, this extract was effective in the reduction of sore throat and hoarseness in patients with difficult intubation.

Introduction: Prelude is one of the ways to overcome the complications of spinal anesthesia. Due to the lack of clarity of the effects of praline on the level of spinal anesthesia, duration and reaching the maximal block and its return, the researchers decided that two normal saline solutions And Voluven in women undergoing elective cesarean section surgery. Materials and method: In this clinical trial study conducted in 1397 with the participation of 70 patients who were candidates for elective cesarean section surgery in Tabriz city hospitals, after selecting the samples, using available sampling method (according to the criteria for entering and leaving the study) Blind random blocks were divided into two groups: A (normal Saline) and B (Voluven). Patients in group A received 10 ml / kg saline from normal saline solution and patients in group B received 5 ml / kg Voluven solution within half an hour before surgery. For parametric variables with normal distribution curve, Independent t test or Unpaired t test and parametric data with abnormal distribution from Mann whitney test and qualitative variables, Chi-square test was used and repeated measures dependent variable test was used in repeated measurements. P <0. 05 was considered statistically significant. Results: There were no significant differences between age, sex, weight, BMI between the two groups of Voluven and normal saline. Also, there was a significant difference in the maximum level of spinal block (P = 0. 670) in terms of time to reach the maximum level of spinal block (P = 0/973) and there was no relation between the two groups in terms of return time to T10 (P = 0. 490). Conclusion: Serum saline and Voluven serum levels can be effective in preventing complications after spinal anesthesia and achieving the maximum level of the spinal block, the time to reach the maximum block level, and the time to return the block.

for treatment is a risk management tool indicating the responsibility of physicians. In this study, we aimed to determine the level of awareness and attitude of residents of Imam Khomeini hospital of Tehran regarding informed consent Materials and methods: This cross-sectional study was performed on a self-made questionnaire which evaluated the attitude and awareness of 100 assistants in the surgical and internal medicine field. The results of this study were analyzed using SPSS software. Results: The mean age of the assistants was 30. 7 years, 45% of them were in the field of surgery and the rest were being trained in internal medicine. 14% of residents had a complete attitude and 41% had no attitude. 27% had complete knowledge and 36% had no knowledge at all. The attitudes and awareness of Imam Khomeini Hospital residents was not significantly correlated with any of the age, gender, academic field, being straight, level of residency, work experience and complaint history. However, the awareness of the residents was correlated with their academic field (p: 0. 04) Conclusion: It seems that we should revitalize our educational policies to improve knowledge and responsibility of our assistants.

Introduction: PTSD is an anxiety disorder which after severe stressful events such as war, earthquake, flood, aggression, accident as well as in occupations where there is human, medical and educational communication and there is more stress, it can be seen. Since the medical emergency personnel in most cases are a first-line service provider to patients and victims are exposed to stress and psychological trauma we decided to research on the prevalence of PTSD and its contributing factors to the medical emergency personnel of Jahrom. Material and methods: In a descriptive cross-sectional study, 100 medical emergency medical personnel in Jahrom, who work as technicians and drivers in these units, were investigated and after receiving satisfaction from the participants, they were given a questionnaire. Mississippi PTSD questionnaire and demographic questionnaire to diagnoses and collect personal information was used. The data were analyzed using SPSS software and descriptive and analytic statistics. Results: The mean age of subjects was 32. 1 ± 4. 8 years and most of them were bachelor's degrees. Among participants, 2. 4% of people were with mild PTSD and the rest were 97. 9% with moderate PTSD and no one had severe type of disorder. Among the four dimensions of the post-traumatic stress disorder questionnaire, the highest score was obtained in dimension of emotional control disorder and then the highest score was followed by disruptions in personal relationships. There was no significant correlation between post-traumatic stress disorder with age, level of education, working hours, marital status, place of mission and work experience (P> 0. 05). Conclusion: Based on the results of the study, most medical emergency personnel in Jahrom, suffer from moderate PTSD that given the importance of their job, it is recommended that training be provided on emotional self-efficacy and coping skills and other emotional readiness.

Background: Central Diabetes Insipidus is caused by the reduction or lack of production of antidiuretic hormone in neurohypophysis, which has many causes. The aim of this study was to determine the frequency and outcome of diabetes Insipidus in operated neurosurgical patients admitted to the intensive care unit of Imam Khomeini in a 5-year period (1393-1393). Materials and methods: This cross-sectional study was conducted in a period of 5 years. Patients' demographic information (age, sex), underlying disease, surgical agent, insignificant diabetes, duration of mechanical ventilation, length of hospitalization in intensive care unit, mortality of patients were extracted from files and entered into a researcher-made form. SPSS 21 was used for analyzing the data. P <0. 05 was considered significant. Result: Of 741 patients, 135 (18. 2%) had central diabetes insipidus and 606 (81. 8%) were without it. The mean of S. G. urinary tract in patients with diabetes insipidus was 1003. 86 ± 4. 35 and in non-diabetic patients was 1015. 76 ± 13. 35 (P <0. 05). The mean serum sodium level in patients with diabetes insipidus was 152. 69 ± 4. 96 and in non-diabetic patients was 139. 26 ± 3. 61 (P <0. 05). The mean urinary output level in patients with central diabetes insipidus was 12. 44 ± 12. 127-12. 127 and in non-central diabetic patients was 97. 58 ± 587. 186 (P <0. 05). Of 135 patients with diabetes insipidus, 72 (53. 3%) discharged and 63 (46. 7%) died. Of 606 patients without diabetes insipidus, 455 (75. 1%) discharged and 151 (24. 9%) died (P <0. 05). Conclusion: The results of this study show that patients with central diabetes insipidus have a poor outcome after brain surgery in comparing with patients without the disease.

Limb-Girdle Muscular dystrophy (LGMD) is a rare hereditary myopathy which involves pelvic and shoulder muscles. Anesthesia management could be a challenge in these patients considering the choice of technique and potential complications in perioperative period. Since it is a rare disease, clinical trials are scarce and most of the information about anesthetic considerations obtained from case reports. Here we have a short review of the disease and the report the choice of spinal anesthesia in a 28 year old lady suffering LGMD undergoing caesarian section. There was no perioperative complication.