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Sequential organ failure assessment (SOFA) is used to assess the severity of the disease and mortality rate in patients admitted to ICU. SOFA requires experiments that are impractical in centers with limited resources. The aim of this study was to compare the diagnostic value of bedside SOFA (b SOFA) and SOFA scores in mortality of ICU patients.

This cohort study was performed in 60 patients with Systemic Inflammatory Response Syndrome (SIRS) older than 18 years of age. SOFA and b SOFA scores were recorded at admission, then daily until admission at ICU.

According to the Lin and Bland-Altman agreement coefficient, there was a very good agreement between SOFA and b SOFA scores at days 1, 15, 16, 17, 18, and 20. At days 3, 5, 7, 14, and 19 we observed a good agreement and significant correlation between SOFA and b SOFA scores. Findings showed a moderate agreement between SOFA and b SOFA scores at days 2, 4, 6, 8, 9, 10, 11, 12, and 13, but at days 13 and 15 there was a direct relationship between the two scores (P>0.05). Area Under Curve (AUC) method in ROC Curve showed no significant difference in diagnostic value between SOFA and b SOFA scores except at day 17 (P>0.05), indicating acceptable diagnostic value of b SOFA score compared to SOFA score. The sensitivity and specificity of the tools in terms of prognosis were found to be very close at different times showing similar diagnostic values.

The study showed diagnostic accuracy, and high sensitivity and specificity for predicting mortality and strong positive correlation between the two tools, so b SOFA is a suitable alternative due to lower cost with greater ease.

Surgery under general anesthesia induces endocrine,immunologic and metabolic responses. During operation,insulin secretion is disturbed and glucose application decreases, catabolic hormons concentration and glucose production increase and hyperglycemia occurs. Hyperglycemia is considered as an independent risk factor for surgery related mortality and morbidity. This study is designed to compare propofol and sevoflurane in blood glucose and hemodynamic variations and post-op nausea-vomiting in laparoscopic cholecystectomy under general anesthesia. This randomized clinical trial was conducted on 320 patients undergoing elective laparoscopic cholecystectomy. They were randomly assigned into remifentanil-propofol (n=160) and remifentanil-sevoflurane (n=160) groups. All patients received intravenous midazolam 1-2 mg, fentanyl 2-3μg/kg and general anesthesia was induced by STP 3-5mg/kg, atracurium 0.5mg/kg or cisatracurium 0.15mg/kg and anesthesia was maintained in 1st group by infusion of remifentanil (0.1-1μg/kg/min) and propofol (50-150 μg/kg/min) and in 2nd group by remifentanil (0.1-1μg/kg/min) and sevoflurane (0.8-1.8% MAC). Blood glucose values and hemodynamic variables was evaluated and recorded in certain times of anesthesia as well as post-op nausea-vomiting. Blood glucose values, mean arterial pressure and heart rates in 1st group (remifentanilpropofol) was significantly lower than 2nd group (remifentanil-sevoflurane) (p<.001).Incidence of post - op nausea-vomiting was not significantly different(p=.36) Maintenance of anesthesia by remifentanil - propofol infusion in comparison with remifentanil-sevoflurane leads to less increase in blood glucose, and lower mean arterial pressure and heart rate values, which reveals less stress response and better hemodynamic stability of propofol; especially in patients with underlying deceases.

Postoperative cognitive dysfunction including Agitation and delirium commonly occurs after cardiac surgery. Ketamine as a NMDA receptor antagonist exerts neuroprotective effects by preventing excitotoxic injury and apoptosis after cerebral ischemia and suppressing systemic inflamematory response to surgery.We studied the effect of intravenous Ketamine during open-heart surgery on post-operative agitation.

In a double blind clinical trial, 40 males at least 55 years undergoing open heart surgery were divided randomly into 2 groups: intervention group (received 0.5 mg/kg ketamine iv before sternotomy and repeated the same dose on the pomp during warming) and control group (the same volume of normal saline). After the end of surgery agitation was assessed by using SAS every 2 hours until 8th hour and then every 8 hours until 3 days.

Incidence of agitation on 2nd and 3rd days after operation was significantly lower in patients receiving ketamine compared with placebo group.

Intravenous ketamine administration during open-heart surgery can reduce post-operative agitation by its neuroprotective effect.