JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2002 | Volume:22 | Issue:37|Papers Count:11

Introduction: One of the main objectives in anesthesia is the administration of proper anesthetic agents with higher efficiency and lower rate of complications.Muscle relaxants play a significant role in achieving this goal. Succinylcoline is a widely used drug anesthesia and in different surgeries. Muscle pain and sore throat following administration of this drug occur as a major complication because of fasciculations, and it seems that prior administration of a subparalyzing dose of nondepolarizing muscle relaxant can prevent fasciculation.Materials and Methods: In this randomized double blind clinical trial, 100 patients were studied between two groups and compared for succinylcholine induced sore throat incidences.Results: The results showed that subparalyzing dose of non depolarizing muscle relaxant (Atracurium) decreased incidence of sore throat down to zero, whereas time, the incidence was 20% among control group.Discussion: We demonstrated that administration of a subparalyzing dose of a nondepolarizing muscle relaxant prior to succinylcholine has a good efficacy in preventing succinylcholine induced sore throat.

It is possible to look in past Holly Defense in many views, and scientific research can be done. One of the most important views is military medicine. As we know one of the serious problems in the war is bleeding due to shooting and explosion. Blood transfusion is the first action against bleeding, but blood transfusion has many complications, and so, we must use it as minimum as possible. Therefore we must know a wounded patient during wounding how much can tolerate bleeding and when we must begin to blood transfusion. In other word we must know how much is the acceptable minimum hematocrit? Many factors influence in optimal minimum hematocrit. Age, Weight, Activity speed of bleeding, sex, place and climate are the factors that influence in tolerable minimal hematocrit. Findings of this research is acquired fro, files and generally 4753 blood bags -transfused to 915 war wounded. Early blood transfusion complications was seen and reported in 7 patients. Wounded patients were average 18 years old.Conclusion of this study is that, war wounded patients are young, and this is a very important factor to homodynamic stability after bleeding.  

Introduction: Correct and ontime CPCR is very important in chain of Survive and the role of physician in CPCR teams is undeniable because most of important decision making and life saving maneuver and skills is done by the physician in critical situations.Despite of this it seems the education of these important topics and skills to medical students is not suitable in medical faculties.Material and Methods: In this descriptive study 81 medical students (43 stagers and 38 interns) were observed by multiple choices questions and checklist for knowledge and skills such as mask ventilation, tracheal intubations, chest compression, etc on the standard Lardall manequins. Accepted scores were evaluated with Mann - Whitney test.Results: Scores of the interns were moderate (between 30 and 49) and the most of the stagers were weak (between 10 and 29), no significant difference was observed between stagers and interns.Discussion: Knowledge and skills of medical students and hence future physicians are far from standard scores and need further attention.

Introduction: Permanent abnormalities of cardiac conductive system lead to homodynamic disturbances and require pacemaker implantation. Pediatric pacing involves unique challenges because of patient size, growth and development and the frequent coexistence of congenital structural heart disease.Objective and Methods: Ninety seven patients, who received permanent pacemaker between 1991-2001 were reviewed retrospectively using patient records. Attention was paid to the implantation type, etiology of pacemaker replacement and the occurrence of any complications related to underlying cardiac structural anomaly.Results: During a mean follow up period of 5.3 years (range 1-14 years) 155 operations have been performed for pacemaker implantation or replacement. Undergoing etiologies for pacemaker implantation have been acquired atrioventricular block in 55 patients (56.7%), congenital atrioventricular block in 33 patients (34%), and malfunction of sinoatrial node in 6, second – degree atrioventricular block in 6 patients and myocarditis in one patient.Epicardial and endocardial pacemakers were implanted for 70 patients (72.2%) and 27 patients (27.8%) respectively. Congenital heart was observed in 62 patients (63.9%). In 44 patients replacement was performed and to three times.Lead malfunction was the reason of pacemaker replacement in 88.7%. Complications were observed in 8% of epicardial and 15% of endocardial pacemaker.Discussion: The 4 years survival rate of epicardial and endocardial pacemakers was 44.8% and 53.3% respectively, but there appeared to be no statistical relationship between the pacemaker type and its survival rate and also the prevalence of complications.Also the congenital heart disease and simultaneous implantion of pacemaker at the time of corrective surgery did not play as a risk factor in decreasing the pacemaker survival rate.

Residual neuromuscular blockade is a risk factor for long intubation and mechanical ventilation and pulmonary complication after cardiac surgery. The patient was a 32 years old women with aspergillus induced endocarditis and mobile vegetation on prosthetic aortic valve that candidate to surgical removal of vegetation. Eight hour after operation the patient emerged from anesthesia and complained about inability to move his hands and feet. On physical examination the patient had symmetric motor weakness in upper and lower extremities without any sensory or other neurological deficit. After ruling out other causes of muscular weakness we administered neostigmine 2.5mg and atropine 1.25 mg that reversed the patient's muscular weakness and she was weaned from ventilator and extubated next morning after surgery. Pancuronium has the highest incidence of residual neuromuscular blokade amongst nondeplarizing neuromuscular blocking agents. In addition this patient had blood urea nitrogen = 32 mg/dl and creatinin = 1.9 mg/dl and received gentamcin before surgery and also she received pancuronium 8mg as intubating dose and 2.1 mg/h as maintenance during operation (total dose of 24mg). Thus in conclusion the residual neuromuscular blockade was not unlikely in this patient.