فهرست مطالب

Archives of Anesthesiology and Critical Care - Volume:4 Issue: 2, 2018
  • Volume:4 Issue: 2, 2018
  • تاریخ انتشار: 1397/02/15
  • تعداد عناوین: 8
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  • Sussan Soltani Mohammadi, Zahra Gholamhosseinzadeh Tabasi Pages 444-447
    Background
    Postoperative nausea and vomiting (PONV) is an unpleasant and distressing complication after abdominal surgeries. We conducted a study to compare the efficacy of Ondansetron-Dexamethasone combination with ondansetron alone on PONV after abdominal surgeries under general anesthesia.
    Methods
    Two hundred patients undergoing elective abdominal surgeries under general anesthesia were allocated into two equal groups and anesthetised with the same technique. In one group combination of 8mg dexamethasone (2ml) and 4mg ondansetron (2ml) and in the other group ondansetron plus normal saline with the same volume was injected ten minutes before induction of anesthesia. PONV at recovery and during the first 24 hours after surgery were compared between the study groups.
    Results
    Twenty-two patients in ondansetron group and nine patients in ondansetron plus dexamethasone group had PONV respectively at first hour in recovery room (P=0.01). Eight patients in ondansetron group and no patient in ondansetron plus dexamethasone group had PONV at first 24 hours after surgery in the ward (P=0.007). In ondansetron group 21 patients and in combination group 7 patients needed intravenous metoclopramide as rescue medication for treatment of PONV in recovery (P=0.02). Two patients in ondansetron group needed intravenous rescue medication for treatment of PONV in the ward (P=0.01).
    Conclusion
    Dexamethasone plus ondansetron was more effective than ondansetron alone in preventing postoperative nausea and vomiting in patients undergoing elective abdominal surgeries.
    Keywords: dexamethasone, elective surgeries, ondansetron, postoperative nausea, vomiting
  • Fariborz Mehrani, Mahsa Fadaee, Sahar Sadat Dehghan Manshadi, Parisa Gozali Kalansara, Kosar Ahmadi, Amirhossein Orandi, Jayran Zebardast, Ali-Akbar Nejatisafa, Saeed Khorramnia, Negar Eftekhar, Hossein Majedi Pages 448-454
    Background
    Low Back Pain (LBP) is a common musculoskeletal disorder which may have an occupational or non-occupational etiology and is seen in many health care providers. It is an important cause of morbidity and workplace absence. Various factors may result in LBP but the role of occupational stress and anxiety personality disorder is still unclear.
    Therefore, the aim of the present study was to investigate the effect of sedation with dexmedetomidine on the incidence of AF in patients admitted to the intensive care unit after CABG surgery.
    Methods
    Face-to-face interviews were conducted with 58 anesthesiologists working in the hospitals of Tehran University of Medical Sciences to evaluate the occurrence of LBP in the first year of work. The probable causes of LBP and the level of anxiety were assessed using a questionnaire designed for this purpose, based on Spielberger state-trait anxiety inventory (STAI), and the results were analyzed.
    Results
    Of 58 participants, 44 (75.9%) were men and 14 (24.1%) were women. The mean age of the participants was 45.6±6.3 years. Twenty-four of 58 participants (41.4%) reported LBP in the first year of work. Six participants (10.3%) did not have anxiety state but had LBP in the first year of work. Eighteen subjects (31%) with mild to severe anxiety state also had LBP in the first year of work. Nine anesthesiologists (15.5%) did not have anxiety trait but had LBP in the first year of work. Fifteen participants (25.8%) had mild to severe anxiety trait and had LBP in the first year of work.
    In general, 24 of 58 participants (41.4%) with an anxiety score of 47.52 (moderate level of anxiety) had LBP, and 34 of 58 participants with an anxiety score of 41.01 (moderate level of anxiety) did not have LBP. There was a significant correlation between the occurrence of LBP and the level of anxiety (P=0.014).
    The personality type, smoking, history of psychiatric disorders, occupational satisfaction, communication with colleagues, sleep quality, history of LBP during work years, especially in the first year, duration of LBP, stress in the first year of work, and weekly hours of exercise had a significant association with anxiety (P
    Conclusion
    LBP is a multi factorial disorder of human. It seems that LBP can be related to stress and mechanical factors.
    Keywords: low back pain, anesthesiologist, anxiety, occupational stress
  • Mohammad Reza Khajavi, Saba Bahari, Reza Shariat Moharari, Pejman Pourfakhr, Farhad Etezadi, Farsad Imani Pages 455-458
    Background
    Postoperative acute pain management after maxillofacial surgery due to severity of pain and limitations of opioids use in these patients is of particular importance. The aim of this study was to evaluate the analgesic effect of oral gabapentin and clonidine combination and opioids requirements after surgery.
    Methods
    This study was a randomized clinical trial (RCT) on 70 patients (18-55 yr old ASAI to II) undergoing various types of Orthognathic surgeries in Sina hospital affiliated to Tehran University of Medical Sciences, Tehran, Iran in 2016. The patients were randomly divided in two groups. Both groups received 1 gr (IV acetaminophen) 0.5 hour before the end of surgery. The control group received placebo and gabapentin/clonidine group received 300 mg gabapentin and clonidine 0.2mg orally 60 minutes before the induction of anesthesia. The pain severity score (assessed by VAS scale, the level of sedation (assessed by Sedation Agitation Scale), opioids requirement, nausea and vomiting were recorded in the post anesthesia care unit (PACU) 5 10, 20, 30 minutes and 3 hours after surgery. For rescue pain management intravenous morphine was administered.
    Results
    Seventy patients were enrolled in this study. Gabapentin/ Clonidine increase extubation time (20.3±9.3min) (P
    Conclusion
    Premedication of oral gabapentin/ Clonidine increases extubation time and sedation score in patients recovering from Orthognathic surgery and could reduce postoperative pain scores and opioids consumption in recovery room.
    Keywords: gabapentin, clonidine, postoperative acute pain, orthognathic surgery
  • Nahid Manouchehrian, Mehdi Sanatkar, Hossein Kimiaei Asadi, Elahe Soleimani, Abbas. Moradi Pages 459-463
    Background
    Shivering is rhythmic vibratory motions in one or more group of muscle that caused after general or local anesthesia. Prevention and early treatment of Shivering lead to not conflict with patient monitoring and also reduce cardio-respiratory and metabolic side effects in patients. The aim of this study is comparing effect of ketamine and hydrocortisone on reducing post spinal shivering.
    Methods
    In this prospective study, 150 pregnant women randomly were divided into three groups after Spinal anesthesia. Patients received 3cc hydrocortisone (2 mg/kg, A group), 3cc ketamine (0.5 mg/kg, B group) and 3cc normal saline (%0.9, C group) intravenously in 10-15 S duration after umbilical cord clamping. In all patients systolic and diastolic pressure, mean arterial pressure, heart rate, oxygen saturation level and body temperature were recorded before anesthesia and then every minute for 5 minutes, every 5 minutes for 15 minutes, every 10 minutes until the end of surgery. Also sedation score, hallucination, nausea and vomiting, intensity of shivering and using amount of pethidine and ephedrine were recorded in questionnaire.
    Results
    All three groups were similar in basic blood pressure, sensory and motor level. The rate of shivering in hydrocortisone group was significantly lower than control group (P=0.000). The rate of shivering in ketamine group was significantly lower than control group (P=0.00). Also the rate of shivering in hydrocortisone group was significantly higher than ketamine group (P=0.004).
    Conclusion
    Intravenous Hydrocortisone and ketamine are effective in reducing shivering occurring after spinal anesthesia in the cesarean surgery, however ketamine is significantly more effective than hydrocortisone in shivering control.
    Keywords: Spinal anesthesia, cesarean section, ketamine, Shivering, hydrocortisone
  • Seyed Taghi Hashemi, Babak Alikiaii, Samira Ghasemi Pages 464-467
    Background
    There is no known biomarker to predict the mortality risk in patients undergoing dialysis in the intensive care unit (ICU). Therefore, the current study aimed to determine the diagnostic value of troponin I and T in this respect.
    Methods
    This prospective study included 70 patients, admitted to the intensive care unit, during 2016-2017, who need hemodialysis.
    In these participants, the serum levels of troponin T and I were measured and the result of treatment was recorded in the patient’s profile whether it was improvement or death.
    Finally, we analyzed the diagnostic value of troponin T and I was predict the mortality in these patients in SPSS software version 20 through the Rock analysis.
    Results
    The mean of troponin I and T levels in alive patients were 0.47±0.11 ng/ml and 0.67±0.15 ng/ml, respectively and in dead were 0.49±0.23 ng/ml and 1.06 ± 0.36 ng/ml, respectively. There was no significant difference between alive and dead patients in the mean of both troponins levels (P value> 0.05). On the other hand, Rock analysis also demonstrated that statistically these two biomarkers did not have any significant diagnostic value to predict mortality (P value> 0.05).
    Conclusion
    According to the results, it is conceivable that troponin I and T are not proper biomarkers to predict the mortality in patients undergoing dialysis in ICU and these biomarkers do not have a proper sensitivity and specificity for this purpose.
    Keywords: Hemodialysis, Troponin T, Troponin I, Mortality
  • Zahid Hussain Khan, Kasra Karvandian, Jayran Zebardast, Hussein Ali Hussein Pages 468-476
    Intraoperative fluid equilibrium is a decisive matter in perioperative anesthesia management, because most of evaluation studies consider intraoperative fluid administration as a major participating agent in improving or worsening patient outcomes after surgery and it revolves within the responsibility of an anesthesiologist. The understanding of fluid physiology in the human body, clinical features of available intravenous fluid, and nature of surgery indeed will contribute to the success plan of management. Maintaining of patients’ physiological milieu by preserving normal extracellular volume, adequate tissue perfusion, and a balanced acid base condition are the main goals of intraoperative fluid infusion. This review was conducted to overview fundamental basics of fluid therapy during the intraoperative period. Due to the dearth of supporting data for appropriate volume and the available definitions of restrictive and liberal are diffident, the polemic about which particular method of volume expansion still exists. Colloid versus crystalloid controversy in surgical patients is still going on and this would again be encouraged to be a topic for many clinical trials in the future. The current findings’ trend prefers guided and restricted intraoperative fluid therapy with isotonic balanced crystalloids because such fluids are cost effective and have fewer side effects than other fluids.
    Keywords: Major surgery, intraoperative fluid therapy, liberal vs restrictive, intravenous fluids
  • Zahid Hussain Khan, Imam Hussain Jameel Khafaji Pages 477-480
    Both neuraxial anesthesia and general anesthesia are used for lower limb surgery. And because of the complications that occur with this type of surgery, we searched in this narrative review the effectiveness and safety of neuraxial anesthesia versus general anesthesia for lower limb surgery. We included randomized controlled trials comparing neuroaxial anesthesia (spinal or epidural anesthesia) versus general anesthesia in adults (35 years or older) with lower-limb surgery.
    Keywords: neuraxial anesthesia, general anesthesia, spinal anesthesia, epidural anesthesia
  • Ebrahim Espahbodi, Anahid Maleki, Abbas Ostad Alipour, Amir Abbas Yaghooti, Alireza Tak Zare, Mehdi Sanatkar Pages 481-482
    letterer siwe disease is a rare disease and anesthesia management of patient with this disease is very challenging because of multiorgans involvement and poor information about anesthesia. We manage a child with this disease was refered to operating room for humerous bone fracture surgery.
    Keywords: anesthesia, letterer siwe