JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2002 | Volume:21 | Issue:33-34|Papers Count:9

Tracheal Stricture and pulmonary aspiration are two considerable problems of the inappropriate cuff pressure of endotracheal tube. In the present study, we measured the pressures in 100 cuffs of tracheal tubes by using a sphygmomanometer gauge. The knowledge of intubing persons about: Perfusion pressure of tracheal mucosa, the required pressure for the cuffs, and the measurement techiques and adjustment of the pressures of cuffs, have been reviewed in a scientific way. The results are as the following:The mean pressure of 100 cuffs was 109±42.6 mmHg. This is approximately fourfold of the required pressure (i.e. 20-25 mmHg).The knowledge of intubing persons about perfusion pressure of tracheal mucosa (normally 20-25 mmHg) includes three groups: 55% of them did not know the pressure; 39% of them knew the pressure in an error margin of ±5 mmHg (Relative Knowledge); and 7% of all those persons had complete knowledge.58% of persons did not know the appropriate measurement techniques and 42% of them did know.

Introduction:Postoperative nausea and vomiting (PONV) occurs in 20-30 percents of patients but is related to patient's condition, method of anesthesia and surgery. This study was done to compare the efficacy of ephedrine, metoc1opramide and promethazine for prevention of PONV with placebo.Study design:The study was done as a randomized doublebline clinical trial on 80 patients with ophthalmologic surgery. patients received 10mg metoclopramide or 25 mg promethazine or 25 mg ephedrine or sterile water, intravenous and prophylactically at the end of surgery. Results:Incidence rate of nausea was 20 percents in control group and 10 percent in the other groups. The incidence of vomiting was 15 percent in control group and 10, 5 and zero percent in ephedrine, metoclopramide and promethazine receivers respectively, but the differences were hot statistically significant.Discussion:Prevention of PONV is recommended in high risk cases; According the results of this-study and literature, the use of serotonin receptor antaginists or metoclopramide is recommended.

Bloodletting acupuncture has heen used for the reduction of various upper respiratory tract discomforts especially of laryngeal origin. In previous trial this remedy has been shown to reduce the incidence of post extubaton laryngospasm in isoflurane anesthetized pediatric patients. In this study the effect of bloodletting acupuncture on the incidence of post extubation stridor has been tested after general anesthesia with halothane. Sixty pediatric patients were randomly divided into acupuncture and control group. In acupuncture group bloodletting acupuncture was performed before extubation. An observer blinded for the intervention, determined the presence of post extubation stridor and its severity. The relative frequency of stridor in acupuncture group was significantly higher than control group. Also the severity of stridor was significantly higher in acupuncture group. It can be concluded that under clinical conditions of pediatric anesthesia with halothane the incidence of post extubation stridor cannot be reduced by bloodletting  acupuncture.

In order to evaluate the prophylactic effect of intravenous magnesium sulfate on hemodynamic complications of larygoscopy and intubation, in a double -blind clinical trial, 90 patients of ASA I or II who were candidate for elective surgery (except pregnant women and cardiovascular diseases), were divided randomly to two groups. Magnesium sulfate 20% (50 mg/kg) was injected to one group after induction of anesthesia, while normal saline (in equal volume) was injected to another group as placebo. Systolic and diastolic blood pressure and heart rate were measured pre - and postinduction, 30 seconds after intubation and by one minute interval for 3 minutes there after. Also duration between first and second dose of nondepolarizing muscle relaxant (Atracurium) was measured. In all of the measured values, there was no significant difference between two groups, except diastolic pressure in 30 seconds after intubation, which was lower in Magnesium sulfate group, and this difference was statistically significant (P<0.05). It was concluded that injecting magnesiu, sulfate after induction of anesthesia has no effect in reducing the complication of laryngoscopy and intubations. Also intravenous Magnesium sulfate does not prolong the duration of action of Atracurium.

Introduction:Amnesia is one of the most important goals in General Anesthasia. From the Point of Psychological views, Awareness in G.A is not desirable, and elimination of it, is necessary. Overall 1% of all patients have awareness and it maybe 10% in some anesthesia techniques. There is not a precise statiscal survey about awareness in NLA. This study attempts to present a statistical work.Methods: All of the 60 patients in this study were 20-45 years old, under spinal surgery and in class I - ASA. All of them have been taken 10mg of Diazepam over the night before operation and 7ml/kg of Ringer solution has been administered in the operating room. (Group A): Neurolept anesthesia started with induction (Talamoonale 0.1 ml/kg, Thiopental 5 mg/kg, Pancuronium 0.1 mg/kg), maintained with N20- Fentanyl (50 mg/30 min) 0.1mg/kg) and maintenance with (Halothane 0.6%, N20, Fentanyl 50 mg/30 min) was administered.A tape player was used during G.A. Patients were requested answer the questions in recovery room and 24 hour after anesthesia. Results:According to Z test, there is no significant difference in awareness between the two groups studied. Also according to X2 test, there is no significant difference in awareness between the two groups studied. All cases of awareness were in 35-45 years of age. Conclusion:In NLA the voice heard by the patient is not perceived unpleasant. According to results, awareness in NLA was not more compared to the other anesthesia techniques. So NLA can be used as a safe technique with more advantage in Poor Risk patients and who needs wake up test during surgery.

Infection is an important cause of morbidity and mortality in the surgical ICUs. The infectious complications occurring in cardiac surgical ICUs, typically involve nosocomial infections or respiratory and urinary tract, surgical wound or intravascular catheters.This study was done on 100 patients that were undergone CABG, from the beginning of the last year. All of patients were similar, and all of them had extracorprial circulation, hypothermia and cardiac arrest. Study was done for infection of heart, sternum, wound and respiratory and uninary tract.Patients were between 32-79 years old. Urinary tract infection was seen in 2 cases, wound infection was seen 7 cases, sternal osteomyelitis in 3 cases and respiratory tract infection in 2 cases and catheters infection was in 1 case. Overall 15 cases or 15% of patients were infected.Nosocomial infections are approximately 5% in patients admitted to hospital.Several studies report an estiamation of two - to five fold increase in the rate of hospital infections for patients in ICUs. In our study the incidence was acceptable, We have to try to decrease this cardiac surgical lCUs complicaton.

During Anesthesia, especially general anesthesia, protective / compensatory mechanisms are attenuated or abolished, for which the anesthesiologist is responsible for until the end of anesthesia. Blinking, which prevents corneal dryness and abrasion, is one of this mechanisms. During general anesthesia eye lids are often open, leaving corneal in front, and thus making it susceptible to trauma due to contact with chemicals, air, cloth, and other things. Two routine ways of shielding cornea are taping arid application of antibiotic ointment. Both ways have their drawbacks. For this reason, application of a moist gause was evaluated and compared to the other two techniques.One hundred and fifty patients were divided into thee groups each comprising of fifty in each groups.

A 37 -year -old women was referred with cataract. The Patient had short stature, thin extremities, loss of subcutaneous fat, high pitched voice, premature graying and pinched face. In Werner syndrome the appearance of premature senility begins in young adult life, although the effects of the disease have had an earlier onset as manifested by moderate growth retardation with decreased height attainment. Free radicals are involved in the aging process. The syndrome is caused by a helicase defect.Because the syndrome is rare and gene analysis is complex, it is unlikely that a commercial Screening test will become available.

Background: Extubation at the end of anesthesia can produce homodynamic changes such as increase in systolic blood pressure, diastolic blood pressure and heart rate.These homodynamic changes can produce irreversible complications in many patients. Thus prevention of these changes would be life saving in high risk patients.Objective:This study was done due to comparison of effect of lidocaine and fentanyl on blood pressure and heart rate changes after extubation at the end of anesthesia. Method:This prospective study has been done on two group of patients (each group included 60 persons) with age limit of 20-55 years old and class I of anesthesia. With method of anesthesia, at the end of operation, in one group lidocaine and in the identical other group fentanyl has been injected. Blood pressure and heart rate has been measured before drug injection, 1 minute and 5 minute after extubation. These information's had been analyzed with t. test.