JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2003 | Volume:23 | Issue:41|Papers Count:10

Techniques that anesthesiologist employ daily in the operating room such as airway management, manual or mechanical ventilation, administring rapidly acting intravenous pharmacological agents, blood and fluids infusion, and cardiorespiratory monitoring - are the mainstays of critical care and therapy. For these reasons, the anesthesiologist is the most proper person than other specialists for the management of ICV.For the purpose of determining of the anesthesiologists role in reducing of mortality in intensive care unit, we designed a retrospective study. We studied 1686 consecutive admission files to ICU during the past two years. There were 756 files related to those patients that had been admitted in 1380 (there was not resident anesthesiologist in ICV) and other 921 files related to those patients that had been admitted in 1381, (there was resident anesthesiologist in ICD). There after, we analyzed the data statistically.The results showed that, the mortality rate of patients had reduced from 38.3% in 1380to 26.9% in 1381.The presence existence of a resident anesthesiologist in ICU is useful and mandatory, because of a speedy access, prompt diagnosis and treatment of critical conditions.

Misplacement of tracheal tube in the esophagus remains a significant cause of morbidity and mortality in anesthesia despite decades of effort aimed at prevention or (more importantly) detection of such an event. We have evaluated a cheap, simple and quick device (Esophageal Detector Device; EDD) which relies mainly on the relation or otherwise of an evacuated elastic bulb applied to the supposed (tracheal) or (esophageal) tube.Identical tracheal tubes were passed into the trachea and esophagus of 100 patients, the left and right position in the mouth was chosen at random.The test was conducted by a second person, not present at intubations and unaware of the tube placed in the trachea. There were no false negatives (relation of elastic bulb applied to the tracheal tubes) probably due to bronchospasm early after induction of anesthesia. Correct deduction of the tracheal tube position was achieved in 98 patients using the device. We conclude that EDD could be a very sensitive (100%) and reliable method for detection of esophageal intubations however, it is recommended in further studies to test the tubes immediately after intubations (when bronchospasm is most probable) to find the exact specificity and accuracy of the device.

Fiberoptic orolaryngeal intubations under general anesthesia may be more difficult to perform if the upper airway cannot be cleared.We studied the effects of jaw thrust, lingual traction, and or both of them in opening the orolaryngeal air space in 76 ASA class I or 2 patients aged 18 and 70 yr undergoing elective general surgery requiring orotracheal intubation. Airway clearance was assessed fiberoptically at the soft palate level by observing whether or not the uvula or soft palate was opposed to the base of the tongue, and at the epiglottic level by observing whether or not the epiglottis was opposed to the posterior pharyngeal wall.Lingual traction cleared the tongue away from the uvula and soft palate significantly more then did jaw thrust (p<0.05). Jaw thrust cleared the epiglottis away from the posterior pharyngeal wall more than did lingual traction (p<0.05). Applying both jaw thrust and lingual traction simultaneously cleared the airway at both soft palate and epiglottis level in all patients. When used alone, jaw thrust and lingual traction fail to produce full airway clearance in a significant number of patients.Combination jaw thrust and lingual traction clears the airway more effectively.

Chronic obstructive pulmonary disease (COPD) is one of the most important causes of mortality and morbidity. Airway hyper responsiveness (AHR) is a specifity that is associated with the therapeutic response, prognosis, severity of disease and pulmonary functions.In this study, the percent of AHR among 50 COPD cases in Shariati Hospital was determined. For this purpose, FEV1 and FVC were determined before and after bronchodilator administration. 68 percent of cases had AHR. There was significant difference between the proportion of AHR in low-risk and high-risk occupational groups, but there was no significant difference between AHR and cigarette smoking, duration of smoking or its cessation. According to the results of the present study and literature reviewed, AHR is a common characteristic in COPD cases. It is recommended to do complementary studies about the association of smoking, specific jobs and drug history with air.

One of the major problems after open heart surgery is the start of alimentation.On the other hand, the recognition of digestive complications is a difficult etiologic variety.This study is performed to determine the time of the return of intestinal peristaltic movements after open heart surgery and its relationship to the length of operation, the time of return of consciousness, extubation time and pump time and also to some of the patients variables such as age, weight and gender.This study was done on 30 patients who underwent CABG or valves replacements.Patients were examined by abdominal auscultation for bowel sounds. Auscultation was done once every hour until at least five bowel sounds per minute were heard.This study showed that abdominal pristaltism returned about 9 hrs and 42 minutes after arrival of the patients to the ICU. We found a good correlation between the time of return of bowel sounds and the time of extubation of the patient.

There is no consensus regarding in induction and controlled sedation which remain as the most important problems in postoperative ICU patients. The aim of this study was to compare the hemodynamic changes including systolic and diastolic blood pressure, and pulse rate after administration of the combination of midazolam + fentanyl, and midazolam + morphine.In a single blind randomized controlled clinical trial, fifty patients who had undergone a major abdominal surgery and needed at least 24 hour mechanical ventilation were enrolled in this study. The age of patients was between 15-40 years. In the group I the patients received midazolam and morphine. In group II they received midazolam and fentanyl. Sedation was measuresd by BIS (BI Spectoral Index).The difference of systolic and diastolic blood pressure in two groups were significant. Systolic blood pressure in group I was (5.4 ± 0.58) and group II (0.24 ± 0.88) [p-value 0.001]. Diastolic blood pressure in group I was (4.12 ± 1.1) and in group II (0.64 ± 1.1) [p-value:0.003]. But there was no significant difference in changes in pulse rate between two groups (p-value=0.4). The combination of midazolam and fentanyl is better in critical postoperative ICU patients whose stability of vital sign is essential.

The aim of this study was a comparison between average serum potassium changes following succinyl-choline injection in patients suffering from closed head injury and non - traumatized patients.This study was performed in Shahid Mobasher Kashani Hospital of Hamedan University of Medical Sciences in 1995.Statistical population consisted of 63 patients suffering from closed head injury and non - traumatized patients admitted to hospital and transferred to operating room. On this basis and by means of the simple convenience sampling, 20 traumatized and 29 non - traumatized patients were selected and their blood samples checked.The exclusion criteria comprised of succinyl - choline usage contraindications.General anesthesia was induced in all patients by rapid sequence induction, with intravenous injection of thiopental and succinyl - choline. One blood sample was drawn just before and another one 5 minute after. The potassium and sodium of blood samples were measured by flame photometry method.Average increase in blood potassium after succinyl- choline injection in non - traumatized individuals was 0.03 meq/l (SD 0.19) and in traumatized group to be 0.05 meq/l (SD 0.22).The results were compared with t - test, which proved no significant difference. (p= 0.5, t= 0.33) It is concluded that succinyl - choline injection causes no significant blood potassium increase in the patient with closed head injury, and dose not cause hyperkalemia. Average blood potassium changes after Succinyl - choline injection in closed head injured and non - traumatized patients have no significant differences.

Snoring is claimed to be a predictive factor for difficult intubations. This study was designed and executed to assess the relationship between the two variables, snoring and difficult intubations.In a randomized double-blind prospective study, 120 cases were selected from the target population, and distributed randomly into two groups. These patients underwent elective surgery and were in the age range of 18 to 60 years. Inclusion and exclusion criteria were defined. Mallampati class and Cormack Lehane grading were used to define and predict difficult intubations. Student-t test and chi-square tests were used for statistical analysis. A p.value of less than 0.05 was considered significant.The two groups had no statistically significant difference regarding ground variables. There was also, no difference regarding Mallampati class. Cormack and Lehane grading scores were higher in the group who had a positive history of snoring.It seems that there is a statistically significant relationship between Cormack grades and the possibility of difficult intubation. However, it is suggested that another study should be done to assess the positive predictive value of this variable for difficult intubation.