JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2006 | Volume:27 | Issue:51|Papers Count:13

Background: Pneumonia is the most frequent nosocomial infection, and a major cause of mortality in the ICU patients. Nasogastric tube is a well known risk factor for ventilator -associated pneumonia NAP). As there are only few studies in non-intubated patients that have concentrated in the role of jejunostomyin prevention of pneumonia, this study is planned. Material and Methods: In this prospective nonrandomized, open label clinical trial study, the VAP cases who were simultaneously fed entirely (nasogastric tube or jejunostomy) are studied. Results: VAP occurred in the 66.7% of patients in nasogastric group and 13.3% of patients in jejunostomy group (sig = 0.002). VAP in nasogastric group was associated with terminal APACHE score of higher than 15 (sig = 0.012) and there was a meaningful correlation between higher terminal APACHE score and mortality (sig = 0.027). On the other hand, in jejunostomy group VAP was associated with primary APACHE score of higher than 15 (sig = 0.002). Simultaneous use of nasogastric tube and tracheal tube willincrease occurrence (sig = 0.040) and also the mortality of VAP (sig = 0.015). Conclusion: Nasogastric tube is a risk factor in occurrence of VAPand its replacement by jejunostomy will decrease the incidence of VAP significantly. As the nasogastric tube and tracheal tube increase the rate of occurrence of VAP and mortality, the alternative use of the jejunostomy together with tracheostomy will decrease the incidence of VAP.      

Background: In this study we have compared hemodynamic responses due to endotracheal intubation (ETT) and insertion of laryngeal mask airway (LMA) in normotensive patients. Materials and Methods: In a randomized double blinded clinical trial sixty patients, (20-40 yrs) with physical status ASA I. who were candidated for elective short time orthopedic .surgeries were divided In two groups of thirty, LMA and ETT. Heart rate (HR), systolic (SBP) and diastolic blood pressure (OBP), before induction of anesthesia (basic amounts) and 1st, 5th and 10th minutes after intubation had been measured. Results: The HR increased after intubation in both groups (p<0.05), and remained elevated at ETT group longer than LMA group (p<0.004). Mean arterial pressure, SBP and OBP increased immediately after intubation in both groups (p<0.05). No significant difference were observed in OBP changes between two groups (p>0.05). Rising of arterial blood pressure was not significant in LMA group. Hemodynamic changes in ETT group were more severe than LMA group (p<0.05). Conclusion: Regarding to less hemodynamic changes in LMA technique compared with ETT, we recommend using LMA, especially in patients suffering from hypertension and ischemic heart disease.      

Background: Adjuvant drugs have been proposed to be accompanied with local anesthetics to decrease onset of block and increase duration of block and analgesic efficacy. In this study verapamil has been added to bupivacaine to assess its additive analgesic effect in interscalene block. Materials and Methods: In a double blinded descriptive analytical clinical trial 60 patients aged 18-40 years and ASA Class I-II were allocated randomly into three groups. In group (a) block was performed merely with bupivacaine (30cc) and 2cc normal saline. In group (b) block was performed with bupivacaine and 2.5mg verapamil and in group (c) with 30cc bupivacaine and 5mg verapamil. Onset of sensory block, motor block and total analgesia and also blood pressure and heart rate were assessed in all groups. Statistical analytic tests were used for data analysis. SPSS software (version 11.5) was used for analysis. P<0.05 was considered statistically significant. Results: Our results clarified that verapamil decreased the onset time of anesthesia, motor block and total analgesia but there were not any statistically difference between adding 2.5 and 5mg verapamil to bupivacaine, (p<0.05). No variation more than 200A, from baseline was detected in blood pressure and heart rate among patients who received bupivacaine plus verapamil. Conclusion: It seems that verapamil could be an effective adjuvant for bupivacaine in interscalene block compared with bupivacaine administered alone, as far as the decrease in onset time of analgesia and anesthesia is concerned.      

Background: Postoperative nausea and vomiting (PONV) is one of the most common problems after general anesthesia. In this study the effect of oral clonidine in prophylaxis of nausea and vomiting in elective abdominal surgery was evaluated. Materials and Methods: This randomized clinical trial was conducted on 50 patients who were in ASA Class I, II.25 patients were grouped in the case and control groups, respectively. Patients were observed for any nausea and vomiting after operation for 24 hours. Results: Out of 25 patients who took clonidine before surgery, 8 patients (32%) had nausea, and 4 (16%) had vomiting. In the control group, 15 patients (60%) had nausea and 11 (44%) had vomiting. Conclusion: Regarding to results, there was significant statistical difference between two groups. In conclusion, "administration of oral clonidine before elective abdominal surgery is effective in preventing postoperative nausea and vomiting." We recommend the use of clonidine in surgeries having a high risk of PONV.      

Background: In our descriptive study during six months, the results of urine cultures and related antibiogram sare studied. Materials and Methods: 40 patients in Taleghani Hospital ICU who had an indwelling urinary catheter for more than 48 hours were studied to determine the common pathogenes and their sensitivity to antibiotics. 20 patients (50%) had positive urine culture and most of the isolated microorganisms had a noticeable resistance to common antibiotics. According to the results Candida albicans with a prevalence of 17.5%, E. coli (15%), Klebsiella (5%), Acinetobacter (5%), Yeast (5%) and Enterococcus (2.5%) were predominant pathogenes. Results: The incidence of urinary tract infection (UTI) (colony count> 105) was 32.5% among all cases but it was 65% among urine culture positive patients. Conclusion: The prevalence of bacteriuria and UTI was more than similar studies in other countries and also most of the pathogenes had a high degree of resistance to antibiotics.  

Background: Succinylcholine 1mg/kg usually produces excellent tracheal Intubation in 60sec. Recovery of respiratory muscle function after this dose however, is not fast enough to forestall oxyhemoglobin desaturatlon when ventilation can not be assisted. In this study, smaller doses of succinylcholine effects were Investigated for producing satisfactory intubation conditions fast enough to allow rapid sequence tracheal intubation with shorter recovery time of respiratory fuction. Materials and Methods: In this prospective, randomized, and double-blind study, 120 patients, Class I or II of ASA was investigated. After induction of anesthesia with fentanyl - thiopental, all patients were randomly allocated to three groups according to the dose of succinylcholine 0.3mg/kg (1×ED95), 0.6 mg/kg (2×ED95), and 1mg/kg (3×ED95). Evoked adductor policicis responses to Train-of-four (TOF) in ulnar nerve stimulation were rewarded using nerve stimulator. Onset time, maximal twitch depression, intensity of fasciculation, tracheal intubation conditions, respiration recovery time (apnea time), time to 90% twitch height recovery. and incidence of postoperative myalgia were recorded. Results: Onset times ranged between 81sec and 49sec, decreasing with increasing doses of succinylcholine but not differing between 0.6 and 1 mg/kg. Maximum twitch depression was similar after 0.6 and 1mg/kg (98.2% - 100%). Intensity of fasciculation was significantly lower in smaller doses. Intubation conditions were often unacceptable after 0.3 mg/kg dose, but acceptable intubations were achieved in all patients receiving a 0.6 and 1mg/kg dose of succinylcholine. Time to respiration function recovery was significantly shorter in the 0.3 and 0.6mg/kg doses (mean 1.8 and 2.4 min. respectively) versus patients receiving 1mg/kg (mean 6.3 min). Twitch recovery time to T1 = 90% (regular spontaneous respiration) were significantly lower in 0.6 mg/kg dose than 1.0 mg/kg group. Incidence of postoperative myalgia was significantly lower in smaller doses versus patients receiving1mg/kg. Conclusion: The use of 0.6mg/kg of succinylcholine can produce acceptable intubation conditions 60sec after administration. The conditions achieved after 0.6 mg/kg are similar to those after 1mg/kg. These smaller doses are associated with shorter apnea time, faster twitch recovery, and lower myalgia.        

Background: Cardiopulmonary arrest is one of the most common medical emergencies and the first and foremost procedure In cardiopulmonary resuscitation (CPR) Is airway management and pulmonary ventilation which if not managed properly can lead to irreversible complications and resuscitation failure. Materials and Methods: In this cross-sectional descriptive study medical Interns at the Shahid Sadoughi Medical University, Yazd, Iran, who had Undergone training in at least two departments were studied. Case selection was by simple random method and 103 Interns were included In study. The interns were evaluated by using an observational check list and special questionnaire by the authors and according to their scores assigned to Weak, Moderate and Good groups. Results: Results showed that the good group included (52.4%) in respect to cleaning the proper positioning of the head &neck and 4.9% for airway placement, only 1.9% for pulmonary ventilation and 0% for endotracheal intubation. Overall, 84.5% were weak in airway management. Chi square test showed a significant relationship between successful airway placement and sex and also time period since start of' internship (p<0.05). Conclusion: The results point out to the fact that practical education in airway management is needed for medical interns. As most of the present education in the field' is observational and class restrictions including indequate assessment does not allow good practical learning, it seems that both practical and observational course in airway management are essential for medical students before the start of their internship.      

Background: The first use of N20 (80% N2O in 20% O2 for labor pain relief was reported in 1880. Labor pain relief should be safe for mother and fetus with less effect on delivery. There are some routs for this purpose, one of them is inhalation of Entonox that consists of N2O 50% 92 50% which is used in this study. Materials and Methods: In a cross-over clinical trial 40 nullipar females candidate for normal vaginal delivery in ASA I, aged 18-28 yrs and without contraindication for use of N2O were enrolled in this study. They received no medication for pain relief until 6-7 cm of cervix dilation at first stage of labor. Then they received continuous inhalation of Entonox. We scaled their pain before and after inhalation of Entonox according to numeric pain scale. Mother vital signs and fetal heart rate were also monitored. Mother satisfaction and neonate APGAR score were also recorded. Results: Three women were excluded from study and candidate for cesarean section due to failure of fetal descending and less, cooperation for continuous inhalation. In other cases mean numeric pain scale decreased from 9.6±0.4 to 3.7±2 after inhalation of Entonox and maternal satisfaction was 64.86% excellent and 35.14% good (p<0.05). Mean APGAR score was 8.9±1.1. Conclusion: Numeric pain scale significantly decreased after Entonox inhalation and worst pain was converted to moderate or mild pain. Short half life of N20 permits that its effect immediately disappear at the discontinuation of Entonox, and less affected delivery.    

Incompatible blood transfusion is not a rare occurrence for the anesthesiologists during their professional life. In this case report a patient with O- blood group who received A- blood during splenectomy is Introduce.