JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2006 | Volume:28 | Issue:55|Papers Count:12

Background: Arterial blood gas (ABG) analysis is useful in evaluation of the clinical condition of critically ill patients. However, arterial puncture may cause many complications. Arterialized earlobe blood gas samplings may be useful alternatives to ABG sampling.This study evaluates whether pH, partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2), base excess (BE), and bicarbonate (HCO3-) values of arterialized earlobe blood samples could accurately predict their ABG analogs for adult patients treated by mechanical ventilation in an intensive care unit (ICU).Material and Methods: 67 patients who were admitted to the ICU and treated by mechanical ventilation were included in this study. Blood samples were drawn simultaneously from the radial artery and arterialized earlobe of each patient. Results: Regression equations and mean percentage difference equations were derived to predict arterial pH, PCO2. PO2, BE, and HCO3- values from their earlobe values. PH. PCO2, BE and HCO3 were all significantly correlated in ABG and earlobe values. In spite of a highly significant correlation the limits of agreement between the two methods were wide for PO2·Conclusion: Arterialized earlobe blood gas can accurately predict the ABG values of pH, PC PO3. BE, and HCO3- for patients with acute respiratory failure being treated with mechanical ventilation.

Background: The patients with fractures of femoral shafts have severe and vigorous pain which limit their lateral positioning to perform spinal anesthesia. To detect an appropriate resolve for decreasing their pain, we decided to compare femoral block and IV fentanyl injection.Materials and Method: This study was performed as a randomized single blind sequentional clinical trial. Prior to spinal anesthesia, pain score evaluated through visual analogue scale (VAS) [from 0 to 10], after that, patients randomly divided into two groups, 10 members in each group. In the first group patients received 1.5 mg/kg fentanyl intravenously. Once their condition was suitable to achieve the position, VAS again assessed. In second group after femoral nerve block (F.B) (20cc lidocaine 2%) VAS evaluated, then the patients positioned laterally to perform spinal anesthesia.Results: This study showed that the time for painless lateral positioning in group F.B was shorter than group IV fentanyl.VAS score for F.B group was lower than IV fentanyl group. The entire information mentioned earlier was analytically significant (p<0.05) and showed satisfactory consequences.Conclusion: In respect to this study, F.B is reliable, safe, inexpensive and It Is feasible to perform in all stages of accidents.

Background: Due to the effects of prone position in improving pulmonary function by Increasing FRC (Functional Residual Capacity), and blood distribution alterations in dependant and non-dependant regions of the lung. We decided to evaluate the effect of position on patients with ARDS in ICU. Material and Methods: In this series study. Hemodynamic indicators in addition to PaO2 of 10 ICU patients with ARDS whom in spite of mechanical support with 100% 02 and maximum tolerable (PEEP) had a PaO2 / FIO2 ratio of less than 300. Were measured 30 min before prone positioning and 30 min. 2 hrs and 6 hrs after prone positioning without any changes in ventilator setting and FIO2.Results: Mean heart rate was increased and systolic and diastolic pressures were decreased. At 30 min after positioning in comparison to 30 min before position changing but remained unchanged through the next 2 measurements. PaO2 was not increased significantly after 30 min of positioning but after 2 and 6 hrs. It was significantly increased. There were also significant differences between the 2 and 6 hrs values of PaO2. Conclusion: Prone position improves respiration in patients with impaired gas exchange due to ARDS.

Background: Thoracic epidural analgesia (TEA) is considered by many. The gold standard for post thoracotomy pain contol but it associated with several fatal potenial complications and technical problems. Some surgeons recently have reported extra pleural paravertebral catheter analgesia (PARA) as an alternative method. Material and Methods: In this perspective randomized controlled trial study a comparison was performed between analgesics affects of these methods together and with systemic morphine administration analgesia in 45 post thoracotomy patients. In TEA group, catheter inserted before operation and 100 mg diluted pethedine injected just before general anesthesia and then repeated every 8 hrs until 72 hours post operative time with 50 mg pethedine. In PARA group, when surgeon wanted to close chest wall a catheter placed in extra pleural paravertebral just near to the thoracotomy incision. Then 10ml bupivacaine 0.25% in 1: 200.000 epinephrine injected via this catheter and repeated every 8 hours till 72 hours post operative. In morphine group 5mg diluted morphine injected intravenously every 6 hours and then data analyzed with treatment according to this study both PARA and TEA provided good pain control without significant difference (p value< 0.071) but they were significantly superior to systemic morphine group (p value<0.001). Incidence of pain related complication did not show significant difference between the groups. Conclusion: Extra pleural paravetebral catheter analgesia is advocated as a routine use in thoracotomy patients.

Background: Intra-operative injection of local anesthetics is going to be more common in daily practice of surgery and postoperative pain management. One of the postoperative pain management is intra-abdominal injection of local anesthetics. The aim of this study was to evaluate the effects of intraabdominal injection of bupivacaine on postoperative pain after laparoscopic cholecystectomy. Materials and Method: In a randomized placebo controlled clinical trial, 60 adult patients with cholelithiasis referring to the Amir-al-momenin Hospital requiring cholecystectomy were enrolled. All the patients underwent laparoscopic cholecystectoy under general anesthesia in a unique manner. In the end of surgery the patients were randomly assigned in the control and bupiva- caine groups. In the bupivacainegroup, intra- abdominal injection 0.8 cc/kg of 0.25% bupivacalne in the gallbladder site was utilized and in control group normal saline injection was utilized. The postoperative pain was evaluated by visual analogue scale 0/AS) in recovery, 2, 4 and 6 hours postoperatively, the total dose of opiate consumption in the first 6 hours, heart rate and mean arterial pressure (MAP) were measured. The 0.5 mg/kg of pethidine was administrated via IM root at patient's request each time. Results: The means of VAS were lower in buplvacalne group compared with control group during the first 6 hours (in bupivacaine and control group were respectively in recovery 32.7±23.62 vs. 89.0±10.6, 43.3±20 vs 66.0±9.3 in 2 hours. 26.7±13.5 vs 65.3±9.3 in 4 hours, 17.0±15.8 vs 69.3±9.8 in 6 hours). Also the means of heart rate and MAP In recovery and 6 hours postoperatively were significantly lower In bupivacalne group compared to control group. Furthermore the mean of opiate consumption and the frequency of patients' analgesic request were significantly lower in bupivacaine group compared to control group (2.5±0.5 vs. 10.3±1.8 mg and 50% vs. 100% respectively). Conclusion: It seems that intra-abdominal injection of 0.8 cc/kg of 0.25% buplvacalne in the galbladder site in patients undergoing iaparoscopic cholecystoctomy significantly reduces postoperative pain and opiate request and consumption.

Background: Post-cesarean delivery pain relief is important. Good pain relief will improve mobility and can reduce the risk of thromboembolic disease, which is increased during pregnancy. Pain may also impair the mother's ability to optimally care for her infant in the immediate postpartum period and may adversely affect early interactions between mother and infant. It is necessary that pain relief be safe and effective and that it results in no adverse neonatal effects in breast - feeding women. Music may be considered as a potential method of post cesarean pain therapy due to its noninvasiveness and lack of side effects. In this study we evaluated the effect of intraoperative music under general anesthesia for reducing postoperative morphine requirements after cesarean section. Materials and Methods: In a double blind placebo - controlled trial, 100 women in ASA I scheduled for elective cesarean section under general anesthesia were randomly allocated in two groups of fifty. After standardization of anesthesia, patients in the music group exposed to guitar in Spanish style after induction of anesthesia up to the time of wound dressing. In the control group patients were exposed to white music. Postoperative pain and anxiety were evaluated by visual analog scale (VAS) up to six hours after discharge from PACU. Morphine was given intravenously for reducing pain to VAS£3 postoperatively. Results: There was not statistically significant difference in VAS for pain between two groups up to six hours postoperatively (p>0.05). In addition, morphine requirements was not different between the two groups at different time intervals up to six hours postoperatively (p>0.05). There was not statistically significant difference between the two groups regarding to postoperative anxiety score and vomiting frequency (p>0.05). Conclusion: in this study, it was shown, intraoperative Spanish music was not effective in reducing postoperative pain after cesarean section. In addition postoperative morphine requirement, anxiety and vomiting were not effected by the music during general anesthesia.

Background: The use of mortality and morbidity index and the length of stay (LOS) in intensive care unit (ICU) are the two primary indexes that describe the efficiency of an ICU.As the analysis of these two indexes might help in improving the efficiency of ICU, this study is undertaken. Materials and methods: An observational cross-sectional study was done on 874 patients who were admitted to ICU of Vali-e-Asr Hospital in Arak from 2002-2004. Age, gender, months of admission place of living, type of diagnosis was considered as independent variables. Mortality rate and length of stay LOS in ICU were considered as dependent variables. For analyzing the data analytic statistics such as Poisson models and mixture Poisson distribution were used.Results: From 874 patients 246 patients died, therefore mortality rate had been 28.1% in ICU. Patient's age was 40±21.8 years and LOS in ICU Was 9.2±11.9 days. The maximum and minimum mortality rate was in December and January respectively. There was a statistical significant difference between the mortality rate in this study and other studies done in other countries. Also, the median of LOS in ICU was 5 days that this value statistical is different than other studies (p<0.01). For LOS values two components Poisson mixture modeling were appropriate model. By using mixture Poisson regression method, patient's age, gender, place of living, type of diagnosis, the ward which patients transfer to ICU from it and month of hospitalization were considered as significant variables for exploring this model. The simple Poisson model was represented fewer variables for explaining LOS in ICU.Conclusion: As the mortality rate in ICU of Vali Asr Hospital is higher than universal statistics, we recommend advanced researches to solve this problem.

Background: We assessed the efficacy of intravenous dexamethasone for prevention of postoperative sore throat. Materials and Method: In this randomized, prospective, double blind, clinical trial study, 86 female patients ASA 1 or 2 undergoing tracheal intubation for gynecological surgery received before intubation either intravenous dexamethasone (0.1 mg/kg) or placebo. Postoperative pain was assessed by the patients using a Visual Analogue Scale 0/AS) and a specific scoring system for sore throat, cough and hoarseness. Evaluations were performed 12 hrs after surgery.Results: Overall incidence of sore throat and cough and hoarseness in both groups was 29% and 34% respectively. There were no statistical differences between incidence of postextubation sore throat (X2= 0.056, df= 1, p= 0.812), cough (X2= 1.55, df=1, p= 0.213) and hoarseness (X2= 0.882, df= 1, p= 0.348) in the two groups.Conclusion: Intravenous dexamethasone is therefore ineffective in the prevention of postoperative sore throat.

Central venous cannulation is an increasingly common diagnostic and therapeutic procedure in modern practice. Inadvertent iatrogenic Injury to an adjacent major artery is rare but it is potentially a lethal complication. If injury leads to pseudo aneurysm, it may produce a mass and embolus or it may even cause severe hemorrhage due to the rupture of the subclavian artery. In this article the incidence of a large right subclavian artery pseudonaneurysm following central venous catheterization is reported.