فهرست مطالب

  • Volume:10 Issue: 5, 2020
  • تاریخ انتشار: 1399/06/31
  • تعداد عناوین: 6
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  • Pooya Derakhshan, *, Seyed HamidReza Faiz, Poupak Rahimzadeh, Reza Salehi, Ghazaleh Khaef Page 1
    Background

    In previous clinical trials and a small number of studies, the fractional injection of anesthetics led to reduced physiological complications and hemodynamic stability and increased duration of anesthesia.

    Objectives

    The present study intended to compare the effect of fractionated and bolus dose injection of bupivacaine and fentanyl on spinal anesthesia for lower limb fracture surgeries.

    Methods

    In this randomized, double-blind clinical trial, 70 patients with lower limb fractures were divided into groups of bolus spinal anesthesia (Group A) and fractional spinal anesthesia (Group B). Group A received a bolus dose of 25 μg fentanyl plus 15 mg bupivacaine 0.5% intrathecally at a rate of 0.2 mL/sec and were laid down in supine position after 45 seconds. In Group B, a half dose of the mixture, i.e., 25 μg fentanyl plus 15 mg bupivacaine 0.5% mixture, was injected intrathecally, and then, the other half was injected after 45 seconds while the needle was still in place. Afterward, the patients were immediately laid down in the supine position. Hemodynamic changes in the sensory and motor blockage parameters were recorded in both groups.

    Results

    The motor blockage onset time was shorter in Group B compared to Group A (P = 0.026). Moreover, the sensory blockage duration was longer (P = 0.035), and the highest level of sensory blockage was lower (P = 0.008) in Group B compared to Group A.

    Conclusions

    Fractional spinal anesthesia led to a longer duration and more favorable levels of sensory blockage compared to the bolus method. In addition, hemodynamic changes and complications occurred less frequently following this procedure.

    Keywords: Fentanyl, Spinal Anesthesia, Bupivacaine, Hemodynamic, Motor Blockage, Sensory Blockage
  • Hassan Ali *, Ahmed Abdelaziz Ismail, Ahmed Abdalwahab Page 2
    Background

    Since the announcement of the World Health Organization of COVID-19 as a global pandemic, the probability of experiencing psychological disturbances and mental health problems among the frontline doctors who deal early with the suspected or confirmed patients is expected to increase, especially among anesthesia and ICU physicians.

    Objectives

    The objective of this study was to assess the magnitude of mental stress among anesthesia and ICU physicians in Cairo university hospitals, Egypt, treating patients exposed to COVID-19.

    Methods

    This cross-sectional, survey-based study collected the demographic and mental health data from anesthesia and ICU physicians working in Cairo university hospitals from March 15 to April 15, 2020, in Egypt. The level of stress was assessed by the perceived stress scale (PSS-10).

    Results

    A total of 193 out of 315 contacted physicians completed the survey. A significant proportion of participants (65%) experienced high levels of psychological distress during this acute situation, with the PSS-10 median score of 21 in the registrar group and 18 in the consultant group; the difference was statistically significant (P = 0.03). The most common causes of stress among the participants were the fears that they might transmit the disease to their loved people and the lack of a clear protocol on how to deal with COVID-19 cases, either suspected or confirmed.

    Conclusions

    In this survey study, anesthesia and ICU physicians responding to the spread of COVID-19 reported high rates of symptoms of mental stress.

    Keywords: Anesthesia, ICU, Mental Stress, COVID-19
  • Ali Dabbagh, *, Dariush Abtahi, Homayoun Aghamohammadi, Seyyedeh Narjes Ahmadizadeh, Seyed Hossein Ardehali, Anesthesiology Department Page 3
    Background

    “Simulated-patient scenarios and role-playing” and OSCE are among the many non-traditional education methods with variable results in different clinical settings.

    Objectives

    This cross-sectional study was performed to assess the correlation between the results of these two methods in senior anesthesiology residents, with a special focus on four of the six ACGME core competencies.

    Methods

    During two years, senior anesthesiology residents were subject to “simulated patient scenario and role-playing” sessions. Two faculty members took the role of the patient and one of the relatives. An objective checklist with 15 items was prepared to be rated by other department faculty members. Meanwhile, an ordered pattern of OSCE was prepared to cover four core competencies that were more related to this academic process (from a total of six core competencies). The mean and standard deviation of the score of each of the 15 items in the checklist were calculated. The correlation between cumulative checklist scoring results and OSCE exam results was assessed. A P value of less than 0.05 was considered significant.

    Results

    A total of 40 senior anesthesiology residents, with 344 assessments by faculty members in 40 sessions, were enrolled in the study. The questionnaire’s Cronbach’s alpha reliability was 0.74. No statistically significant disparity was detected between the results of the two assessment methods, while the results of the two assessments had a significant correlation (two-tailed correlation coefficient = 0.886; P value < 0.001).

    Conclusions

    There was an objective relationship between the results of “simulated patient scenario and role-playing” strategies and the results of OSCE exams using an observer-based rating method. Thus, they could be used as surrogates in the assessment of core clinical competencies of senior anesthesiology residents.

    Keywords: OSCE, Anesthesiology, Resident, Role-Playing, Residency Program, Simulated Patient Patient Scenario
  • Ehsan Bastanhagh, Fahime Zamiri, Saghar Samimi Sadeh*, Khadijeh Adabi, Pejman Pourfakhr Page 4
    Background

    Pain is one of the most challenging issues following surgery, and it is crucial to provide adequate and appropriate pain control measures.

    Objectives

    This study assessed the efficacy of preoperative duloxetine in controlling postoperative pain in women following an abdominal hysterectomy in Yas Hospital affiliated to Tehran University of Medical Sciences between December 2019 and April 2020.

    Methods

    The study involved 80 women who were candidates for elective abdominal hysterectomy. The participants were randomly assigned to one of two groups. Group 1 received a 60 mg duloxetine capsule two hours before surgery. Group 2 received placebo following the same schedule. The amount of administrated opioids and the time from surgery to the administration of opioids were recorded, along with the frequency of nausea and vomiting experienced.

    Results

    Two patients from each group withdrew before the study ended. In total, 38 women in each group were assessed. There were no significant differences in age, duration of surgery, and the amount of administrated opioids between the two groups. However, the number of patients who had nausea and vomiting differed significantly between the two groups (65% vs. 34%; P = 0.006).

    Conclusions

    Our findings showed that duloxetine was not effective in controlling pain after abdominal hysterectomy. In addition, patients who received duloxetine had a significantly higher rate of nausea/vomiting.

    Keywords: Pain, Duloxetine, Hysterectomy, Opioid Consumption
  • Fatemeh Javaherforooshzadeh *, MohammadReza Pipelzadeh, Reza Akhondzadeh, Sara Adarvishi, Mostafa Alghozat Page 5
    Background

    The benefit of sequential compression device (SCD) for the prevention of hypotension after spinal anesthesia in cesarean sections has not been determined.

    Objectives

    In this study, an attempt was made to determine whether SCD can prevent hemodynamic changes following spinal anesthesia for cesarean sections.

    Methods

    In a prospective clinical trial, 76 parturient women undergoing elective cesarean sections under spinal anesthesia were randomly divided into SCD or control groups. The maternal hemodynamic changes within 75 min after spinal anesthesia, nausea, vomiting, and neonatal Apgar score at 1 and 5 min were compared between the groups.

    Results

    There were no significant differences between the groups in the patients’ characteristics, maximum sensory block, skin incision to delivery time, spinal anesthesia to delivery time (min), and the total duration of surgery. Concerning heart rate changes, RM ANOVA showed a significant difference in the effect of time, groups, and the interaction of the two factors (P < 0.0001, P < 0.0001, and P < 0.0001, respectively). Tukey post hoc test showed that 3 min after spinal anesthesia, diastolic blood pressure was significantly higher in the SCD group than in the control group (P < 0.05). The SCD group had meaningfully lower rates of nausea (P = 0.005) and vomiting (P = 0.001) than the control group. The SCD group also demonstrated a significantly lower mean ephedrine dosage per patient (4.1 mg against 17.1 mg, P = 0.001). However, no significant difference was observed between the groups in terms of neonatal Apgar scores at 1 and 5 minutes.

    Conclusions

    This study showed that SCD could reduce extensive changes in diastolic blood pressure as an important hemodynamic parameter and the incidence of nausea and vomiting. Thus, SCD can be used in spinal anesthesia care practices for elective cesarean sections.

    Keywords: Cesarean Section, Spinal Anesthesia, Hemodynamic Changes, Sequential Compression Device
  • Gelareh Biazar, Farnoush Farzi *, Yasmin Chaibakhsh, MohammadReza Habibi, Mahsa Khosousi Sani, Ladan Mirmansouri Page 6
    Introduction

    Meperidine is known as the gold standard drug for shivering after spinal anesthesia (SA). This drug has been used widely and safely during the Cesarean Section (CS).

    Case Presentation

    This case report presents an anaphylaxis reaction to a single intravenous dose of 25 mg meperidine, aiming to control shivering during CS under SA a few minutes after surgical incision.

    Conclusions

    The condition was well managed with timely intervention. This rare fetal reaction to meperidine is worthy of reporting to make the medical team aware of the potential risks of anaphylaxis due to many routine safe drugs.

    Keywords: Anaphylaxis, Meperidine, Cesarean Delivery