JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2018 | Volume:40 | Issue:1 (101) |Papers Count:9

the same as general anesthesia, affects the process of temperature regulation. The aim of this study was to compare the prophylactic effect intrathecal sufentanil with meperidine on prevention of shivering during spinal anesthesia in patients underwent orthopedic surgery of the lower limb. Materials and methods: Ninety patients were randomly recruited to receive either 3 ml of 0. 5% hyperbaric bupivacaine plus 2μ g of sufentanil (Group S), or 3 ml of 0. 5% hyperbaric bupivacaine plus 0. 2 mg/kg of meperidine (Group M), or 3 ml of 0. 5% hyperbaric bupivacaine plus normal saline (Group C). The incidence and intensity of shivering, blood pressure, heart rate and total intravenous meperidine were compared in three groups. Findings: Total incidence of shivering was lower in study groups during surgery and recovery was significantly different between three groups (P=0. 03, P=0. 001). Also the intensity of shivering during surgery and recovery was significantly different between three groups (P = 0. 001, P=0. 01). Total dose of intravenous meperidine was significantly lower in study groups versus control group (P=0. 03). There is not significant different in hemodynamic parameters between three groups. Concclusion: We concluded that intrathecal sufentanil and meperidine can decrease intensity and incidence of shivering compared to control group as well as decreasing the requirement to additional doses of meperidine for shivering the control without any hemodynamic side effect.

Introduction: Different doses of morphine affect on cardiac myocytes by k and δ opioid receptors. This study is aimed to determine the effects of morphine addiction on lesion size of myocardial infarction and levels of creatine phosphokinase andlactate dehydrogenase in rats. Materials and methods: This study was performed on 30 male wistar rats weighing 200-250gr. The rats were divided into 3 groups includingcontrol, test 1 (administration of chronic morphine + myocardial infarction + 40mg/kg morphine) and test 2 (administration of chronic morphine + myocardial infarction + 20mg/kg morphine). Myocardial infarction was induced by ligation method. After two days rats were killed and blood and heart sampleswere isolated for measurement of creatine phosphokinase and lactate dehydrogenase and infarction size respectively. Results: This study showed that administration of morphine decreases the infarction size, creatine phosphokinase and lactate dehydrogenase, in study groups. Conclusion: According to the results of this study, prescribing morphine to addict patients, before myocardial infarction, in doses that they used before, may reduce withdrawal symptoms and myocardial infarction size.

Introduction: Today, cost reduction and resource planning play an important role in managing hospitals. Hospital, s intensive care departments have the most expensive beds. The prediction model for length of stay is a tool for optimal management of beds and scarce resources in intensive care units. Our goal in this study is to provide models for predicting the patient length of stay in neurocritical care unit using data mining techniques. Materials and methods: In this study, RapidMiner data mining software was used for modeling in order to classify and construct the prediction model for patients admitted to the neuro-critical care unit of Loghman Hakim Hospital in Tehran. The data of this study were extracted from 592 patients admitted to the intensive care unit between 94-97. Artificial neural network, K-nearest neighbors, decision tree and random forest algorithms used to classify the patients. Finally, the confusion matrix was obtained to calculate accuracy. Results: The findings of this study indicate that the type of surgery and the pneumonia as a complication have the greatest impact on the length of ICU stay. Also, the accuracy of the algorithms used to construct the prediction model was: decision tree 84. 28%, random forest 83. 96%, artificial neural network 83. 79%, and the K-nearest neighbors, 77. 90%. Conclusion: Models of four techniques used in this study were able to predict the length of ICU stay. But the findings from the confusion matrix showed that the Decision trees with accuracy 84. 28% had a relatively better performance among the techniques studied and the rules extracted from the decision tree could serve as a model for predicting the patient's stay in the neuro-critical care unit to be used.

Introduction: Long-term fasting before surgery can lead to serious post-operative complications. The aim of this study was to evaluate pre-operative fasting in elderly people and its subsequent implications. Materials and methods: This is a cross-sectional study that was carried out from March 2009 to March 2009 in the educational hospitals of Iran University. 151 elderly, who were candidate for surgery, participated in this study. The data gathering tool was a researcher-made checklist which its validity was obtained through content validity and its reliability was obtained through calculation of the correlation of the evaluators’ assessment scores. Data were analyzed using spss21 software. Results: The findings showed that, 69 (45. 7%) of participants were men and 82 (54. 3%) were women, 51% had cardiovascular disease. The mean overall duration of fasting was 11. 7 ± 2. 79. Only 30 of them experienced a 6-8 hours fasting period, while 19 patients experienced 10-8 hours, 46 patients were NPO (Nothing by mouth )for 10-12 hours, and 56 were more than 12 hours NPO before surgery. Conclusion: Based on the results of this study, it seems that preoperative care in elderly people, especially about duration of NPO time and attention to assessment of vital sign and Comorbidities, is not sufficiently precise. Therefore, it is recommended that caregivers receive adequate education about preoperative care.

Introduction: The prevalence of burnout syndrome (BOS) is higher in physician than in other professions and it is especially higher in anesthesiologist. The development of BOS is related to an imbalance of personal characteristics of the employee and work related issues. BOS is associated with many dexterous consequences, including increase rate of job turnover, reduced patient satisfaction, and decreases quality of care. BOS also directly affects the mental health and physical wellbeing of the large number of anesthesiologists. Purpose: To evaluate the prevalence of BOS among Iranian anesthesiologist to raise the awareness. Methods: Between September and November 2017, Mini-Z Survey was conducted to evaluated burnout among anesthesiologist including residents and fellowships. All questions of the survey were according to American Collage of Physician Utah Data. The online Survey Monkey Software was used to receive feedback from Iranian anesthesiologist. Results: Of 100 participant anesthesiologist who completed the survey, overall 63% were not satisfied with their job, 89% has felt a great deal of stress and 28% reported their own definition of burnout. Twenty-eight percent had no control over their workload, sufficiency of time for documentation was not satisfactory in 75% of anesthesiologists and atmosphere in their work area was not reasonable in 36%. The professional values of 42% was not aligned with department leaders and team work were not satisfactory in 47% of cases. In 30% the amount of time they spend on the electronic health record was not satisfactory although their proficiency was not satisfactory in 53% of cases. Conclusion: Overall Iranian anesthesiologist are not pleased with their job and feel a great deal of stress. A better understanding of the factors that sustain anesthesiologist satisfaction and studies testing interventions to reduce burnout is needed.

Background and Aim: Despite the emphasis on the teaching and training of non-technical skills and teamwork based on CPR guideline (2015), the concept of non-technical skills in CPR is not well-known and clear in social and cultural context of medical sciences in Iran. Materials and methods: Using the hybrid analysis of Schwarz-Barcott and Kim's concept analysis, which consists of three phases: theoretical, fieldwork and final analysis, the concept of non-technical skills in CPR was analyzed. Results: Literature review in the theoretical phase determined the attributes of the concept including management, leadership, communication, situation awareness, and task management. At the stage of fieldwork, the attributes such as management, leadership, communication, similar to the results of the previous stage were emphasized, and another class was established under the title of professional competence of members of code 99 with the subcategories of ethical, scientific and practical skills, which in the final analysis, was identified as a prerequisite feature in membership code 99. Conclusion: Concept analysis of non-technical skills in CPR reminds us of the need to pay attention to its key elements. In the meantime, this concept is a new and complex one within the context of our country, so it is recommended to perform the more studies, using a variety of data collection methods, across the country, then different aspects of this concept will become clearer in the context of the medical sciences.

Introduction: This study was aimed to investigate and compare the intravenous methadone and sufentanil effects on bleeding volume in opioid addicted patients undergoing coronary artery bypass surgery in Imam Ali Hospital in Kermanshah. Materials and methods: This experimental study was a clinical trial. In this study, all patients with opium, heroin or codeine addiction undergoing coronary artery bypass surgery referred to Imam Ali Hospital in Kermanshah were interred in this study and randomly divided into two groups of methadone treated and sufentanil treated patients. The patients undergoing off-pump surgery were interred in this study. The patients without exclusion criteria were randomly divided to patients received methadone 0. 5 mg / kg and patients received sufentanil 3 micrograms / kg during and after surgery, and 0. 5-2 mg of methadone and 5-10 micrograms of sufentanil in intensive care unit. In each group, bleeding volume was recorded according to the blood volume of the drain. Bleeding volume was measured during 24 hours a day in the intensive care unit. The information was collected using a questionnaire and analyzed by SPSS software. Results: The mean age was 63. 83 ± 8. 84 in the patients receiving methadone and 66. 48 ± 8. 11 in the patients receiving sufentanil. In the methadone group, 50% were male and 50% were female. Also, in the patients received sufentanil, 50% were male and 50% were female. Mean bleeding volume in the operating room was significantly higher in the sufentanil group than the methadone group. Also mean bleeding volume in the intensive care unit was significantly higher in the sufentanil group than the methadone group. Conclusion: This study showed that the bleeding volume, both in the operating room and in the intensive care unit was significantly higher in the opioid addicted patients who received sufentanil over than the methadone group. Therefore, with considering the lower side effects of methadone and other benefits, it seems that methadone is a good option in these patients.

Central Venous Catheter (CVC) placement is a common procedure that is performed for hemodynamic monitoring and rapid access to systemic blood circulation especially in critically patients. Some complications include subcutaneous hematoma, vascular injury, inappropriate catheter placement, infection and pneumothorax that have been mentioned in various articles and documents. One of these complications is severe cardiac arrhythmia including ventricular arrhythmia and Complete Heart Block (CHB) which, although is rare, but can be a serious lifethreatening cause of patient death. In uremic patients, when a proper fistula or graft is not available for hemodialysis, Shaldon is used. But most physicians use less internal jugular veins because of the risk of infection. This report is about a Uremic woman with LBBB, who urgently needed to have Shaldon embedded for hemodialysis, but suddenly she suffered bradycardia and asystol and eventually a Complete Heart Block (CHB).