JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2017 | Volume:38 | Issue:1 (97) |Papers Count:11

Introduction: The aim of this study was to assess the effect of premedication with intravenous midazolam or fentanyl on anxiety and hemodynamic changes following spinal anesthesia in pregnant women.Materials and methods: 145 pregnant women scheduled for cesarean section were randomly recruited into three study groups in this randomized clinical trial. The severity of anxiety in all women were assessed using Depression Anxiety Stress Scales (DASS) at the time of entrance to the operating room. In first group (group Midazolam) 1 mg midazolam (in 1 ml volume), in second group (group Fentanyl) 50 mg fentanyl (in 1 ml volume) and in third group (group control), 1 ml normal saline were administered intravenously before preparing for anesthesia and then spinal anesthesia was done for all women in lateral position. Variables such as age, body mass index, duration of surgery, level of sensory block, gravidity, Apgar score, heart rate, systolic, diastolic and mean arterial pressure before spinal anesthesia and then after every minutes until 5 minutes and then every 5 minutes until the end of surgery were recorded for all patients. Data were analyzed using SPSS (version 22).Results: Demographic variables, duration of surgery and Apgar score of neonates were not different between study groups. Women in three group were not different with respect to incidence of hypotension and bradycardia needed to treatment. The incidence of hypotension and bradycardia in patients with severe anxiety were statistically different between control and midazolam groups, but the same difference was not seen in patients with mild, moderate and very severe anxiety.Conclusion: In this study, we showed that intravenous midazolam before spinal anesthesia for cesarean section can decrease the incidence of hypotension and bradycardia in patients with severe anxiety without any risk for mother and her neonate.

Introduction: Flexible cystoscopy is an easy and safe procedure for diagnosing and following in patients with lower urinary tract signs, hematuria and bladder cancer; and is one of the most common procedure in the outpatient urologic clinics. The pain and signs after flexible cystoscopy are less than rigid cystoscopy. Some patients; specially, at the entrance of scope complain from pain and discomfort; although flexible cystoscopy can be tolerated well. Many options are available to the decrease postoperative cystoscopy pain. In this study we proceeded to the comparison of lidocaine gel and methoxyflurane effects in relieving pain during cystoscopy.Materials & methods: After obtaining informed and written consent sixty patients between 20 and 55 years undergoing a cystoscopy procedure enrolled in this interventional study and were assigned to receive methoxyflurane or lidocaine 2% gel in a non-blind manner. Patients were randomly allocated into two groups, one inhaled 8-10 breath of methoxyflurane before cystoscopy entrance and the other received lidocaine 2% gel 15 minutes before procedure. All subjects were evaluated and compared regarding heart rate, blood pressure, oxygen saturation and pain (utilizing numerical analog scale, from 0-100), before entrance, at the time of drug administration, just at the instrument insertion, during bladder examination, end of procedure and 15 minutes after operation. Pain score more than 30 (based on NAS), treated with alfentanyl 10 m/kg. Total dosage of alfentanyl between two groups were compared. We used Penthrox inhaler for administration of methoxyflurane with activated charcoal scavenging chamber. (methoxyflurane concentration 0.5-0.7%). For each patient we used maximum one vial (3cc) without oxygen. After two weeks; BUN, CR, SGOT, SGPT and alkaline phosphatase were measured.Results: The numerical analog scale for cystoscopy (P<0.0001) were significantly decreased in methoxyflurane group. Patient desire to repeat procedure if needed was significantly higher in Methoxyflurane group. Opioid consumption was significantly lower in Methoxyflurane group. There were significant differences in systolic blood pressure during scope insertion and intravesical examination.Conclusion: Methoxyflurane is an effective analgesic for rigid cystoscopy related pain in men under 55 years old which had opium sparing effect during scope insertion and intravesical viewing.

Introduction: Ventilator-associated pneumonia is One of complication of mechanical ventilation and Its diagnosis in surveillance system based on the judgments of clinical, causing a large difference in reporting it. Centers for Disease Control and Prevention (CDC) has used objectively measures (ventilator-associated events) to overcome these barriers. Considering that in Iran, for surveillance system and reporting ventilator-associated pneumonia in hospitals, as well as from previous surveillance definitions of CDC are used, and the new surveillance definitions (VAE) are supposed to replace the previouse surveillance definitions in Iran, this study was conducted to compare ventilator-associated pneumonia based on previous and new surveillance definitions of CDC.Materials and methods: In order to do this prospective study, Information on surveillance system in 4 intensive care units during 1 month were collected. The diagnosis of ventilator-associated pneumonia with CDC previous definitions (PNEU1) based on radiographic finding and clinical signs or symptomes (cnange in temperature, change in white blood cell count, altered mental status, change in respiratory secretions, cough or dyspnea, rales and worsening gas exchanges) and ventilator-associated events (VAE) based on daily minimum PEEP or FIO2, change in temperature, change in white blood cell count, start of new antimicrobial agent and culture of respiratory secretions, lung tissue, pleural fluid or lung histopathology.Results: 12 Ventilator-associated pneumonia during a month in which all of them were PNEU1. Ventilator- Associated Events, in 6 cases (50%) were seen; 2 (33%) were Infection-related Ventilator-Associated Complication (IVAC) and 4 (67%) were Possible Ventilator –Associated Pneumonia (PVAP). ventilator associated events revealed about half of the cases of ventilator associated pneumonia. McNemar non-parametric test showed no significant difference between the two methods (P=NS), obtained content of the agreement between the two methods using the Kappa was 0.656.Conclusion: In our study, VAE surveillance detected half of VAP cases, but there was no statistically significant difference between the two methods which may be due to the small number of pneumonia cases and short duration of study. Also, given that the new surveillance definitions are supposed to be in place of the previous definitions in Iran and this, requires the accurate recording and daily monitoring of PEEP or FIO2 in the manual chart of intensive care units and requires a sufficient number of trained personel.the operation of Ventilator –Associated Pneumonia based on the new surveillance definitions of CDC, requires further study in Iran.

Introduction: Complementary therapies are a low cost and non-invasive method, which is aimed at creating comfort in stressful situations; the aim of this study is effect of aromatherapy with rose on physiologic parameters and mechanical ventilation weaning time of patients undergoing open heart surgery.Materials and methods: It’s a randomized clinical trial study, which is done on 120 patients undergoing open heart surgery in 2016. Patients were randomly allocation into three groups including; intervention groups, control group and placebo group. After transferring patients from the operating room to the ICU open heart (ICUOH), the first basic vital signs were documented for all the three groups from the monitoring device with the patient’s first inspiratory effort. In the experimental group, after beginning patient’s first inspiratory effort, intervention was done by putting a cotton impregnated with three drops of rose essence and attaching it to the patient’s endotracheal tube and in the placebo group, intervention was done with a cotton impregnated with water, but there was no intervention in the control group. Then patients’ vital signs were controlled and documented every 30 minutes as long as endotracheal tube is not extracted and extubation, it was done every 15 minutes until one hour. Data analysis was done by using descriptive and inferential statistical method (Chi-square, ANOVA, Tukey, repeated measures variance analysis) through SPSS23 software.Findings: Results of the study were indicating that aromatherapy with rose did not cause any statistical significant difference in physiologic indicators. Decreasing arterial systolic blood pressure among the three groups during the first 15 minutes, the first 45 minutes and the first 60 minutes after extubation have significant statistical difference. Despite statistical significant difference, this difference is not clinically significant. Aromatherapy is effective in shortening the length of weaning time (P=0.03).Conclusion: Considering positive effects of aromatherapy on hemodynamic indicators, it can be used as an effective alternative treatment.

Introduction: Pediatric patients show various reactions during emergence from general anesthesia. Many cases of emergence agitation after anesthesia have been reported and pain was suggested as a major contributing factor. The purpose of this study was to evaluate the effect of sub-Tenon lidocaine injection on emergence agitation and pain in children after strabismus surgery.Materials and methods: In a randomized clinical trial, 40 children, aged 5-10 years, who were scheduled for strabismus surgery, were enrolled. Children were randomized two groups and at the end of surgery, the surgeon injected 1 ml of 2% lidocaine into the sub-Tenon space in study group and in control didn’t inject any drug. Pain and sedation were assessed in the post-anesthesia care unit using FACEs pain rating scale and Ramsay sedation scale respectively.Results: Patients in the sub-Tenon's lidocaine group had significantly lower pain scores in compare to control group (2.8±0.6 vs 4.6±1.7; p=0.0001). Ramsay sedation scores also were higher in sub-Tenon' s lidocaine group (2.7±1.2 vs 1.2±0.4; p=0.0001) Conclusion: In children undergoing strabismus surgery, sub-Tenon's block provides more effective analgesia and sedation.

Introduction: Today pulse oximetry is widely used for continuous monitoring of oxygen saturation. Although finger pulse oximetry cannot be used in some conditions including burn, blood pressure decline, and restlessness. There are lots of clinical evidence that ear pulse oximetry with finger sensor is utilized in these conditions. Thus, this study aimed to Comparison the precision of ear and finger pulse oximetry with finger pulse oximeter sensor in patients receiving vasoactive therapy.Materials and methods: In an analytical study on 33 patients under Treatment with Vasopressor Drugs, who were selected by convenience sampling based on inclusion criteria, two finger pulse oximeter sensors were connected - one to the top of ear, the other to the fingertip, and arterial blood samples taken simultaneously. Data were analyzed using statistical software SPSS 22 with Spearman correlation test and analysis of variance with repeated measures. The level of significance was considered less than 0.05.Findings: The findings showed that there was a statistically significant difference between oxygen saturation percentage of the ear, fingertip, and arterial blood (P<0.001). Furthermore, there was a significant correlation between oxygen saturation percentage and CRT.Conclusion: current study showed that finger and ear pulse oximetry with finger sensor in patients under treatment with vasopressor drugs have similar accuracy for oxygen saturation percentage, although SpO2 of ear is 3% higher in average and SpO2 of fingertip was about 3% lower than SaO2.

Introduction: Scleral buckling is one of ophthalmic surgeries which may present as postoperative pain. One of the methods to control such a pain can be preemptive analgesia. There are limited studies in this regard. We evaluated the efficacy of preventive analgesia for reduction of postoperative pain by using peribulbar block via local anesthesia, acetaminophen pills & diclofenac Na suppository prior to scleral buckling surgeries.Material & methods: Our final sample consisted of 120 patients selected for scleral buckling surgery & divided into 4 groups. Each group had 30 patients including group 1 or peribulbar with 5ml lidocaine 2%, 5ml bupivacaine 0.5% & 150 IU hialoranidase injected peribulbar before surgery, the second group using acetaminophen 325mg tablets every 8h from 24h prior to surgery third group using diclofenac Na 75 mg suppository every 12h from 24h prior to surgery four group or control group did not receive any additional analgesia. All of the patients underwent general anesthesia similarly. The verbal pain score after surgery, the first time of requesting analgesic consumption after surgery, post anesthetic nausea & vomiting & the incidence of occulocardiac reflex during surgery were studied.Results: The first time of requested analgesia after surgery among peribulbar group (group 1) 58±20 minutes, among the second group 36±20 minutes, among the third group 34±12 minutes & 1n group 4 40±18 minutes were seen (P<0.05). The mean of using petheidine in group1 (peribulbar) 9.3±6 mg in the second group 19±6.6 mg, in third group 18±5.3 mg & 20±6.9 mg for the fourth group were achieved (p<0.05). The mean of the frequency of oral analgesic drugs after surgery in the first group (0.9), in the second group (2.7), in third group (2.3) & in the fourth group 2.8 were seen (p<0.05).Conclusion: Peribulbar block with local anesthesia associated with general anesthesia prior to operation of scleral buckling considerably causes to reduce postoperative pain, prolong the first time of analgesia request after surgery and decrease the frequency & the mean of postoperative analgesic drugs as well as the incidence of PONV & occulocardiac reflex will be decreased.