فصلنامه آنستزیولوژی و مراقبتهای ویژه ایران
سال چهل و سوم شماره 3 (پیاپی 111، پاییز 1399)

Nausea and vomiting is one of the most frequent and devastating complication after surgery. Most important predicting factors are type of surgery and anesthesia and patients’ factors.Incidence of PONV is reported as high as 20% to 30% up to 70% to 80% in special populations. PONV is one of the most annoying and frequent complication of cancer surgery too. It is also prolongs hospital stay and increases Day care surgeries discharge problems after Breast cancer surgery.

174 patients candidate for breast cancer surgery enrolled in this prospective descriptive study to assess the incidence of PONV and POND in Shohada Tajrish hospital in 2019 to 2020. It is also prolongs hospital stay and increases Day care surgeries discharge problems after Breast cancer surgery.

On the day of surgery, nausea in the highest range was (35.1) and vomiting was (14.3). 24 hours after discharge, 33.6% of patients had nausea, while 10.6% of patients had vomiting. 48 hours after surgery, nausea and vomiting decreased to 18.8% and 6.3%, respectively. In this study, the overall incidence of nausea was 37.2% and vomiting was 15.8%.

Although PONV and PDNV are known as important problems that need clinical management, it looks our knowledge and capability of handling them is limited.

The prevalence of chronic pain after surgery is between 10 to 50 percent; Due to the fact that chronic pain after surgery is still unknown and there are different drug regimens are used for it, and as a result, preventive and curative measures are unknown to physicians, we decided to conduct a review study of chronic postoperative pain management.

This study was a systematic review based on PRISMA steps and clinical trial articles published till the end of 2020 in MEDLINE, Embase, PsycINFO, CINAHL and Cochrane libraries with the keywords of chronic pain, surgery, pain management.

66 studies were entered with data from 3149 participants in this study; All were clinical trial studies examining the effects of medication on the management of chronic postoperative pain; Drugs used included antidepressants, antiepileptics, capsaicin, epidural injections, neurotoxins, N-methyl-d-aspartate receptor antagonists, and opioids whose effects were evaluated.

Chronic pain after surgery is very unpleasant for every patient and it can lead to various complications for the him/her, so it is important to control and manage the situation with appropriate modality; Different drug regimens have been used to control it, and in studies, methods such as the use of injectable opioids, as well as oral medications such as pregabalin and gabapantin were the most effective treatments.

Labor pain is known as severe pain; Lack of pain control causes wide-ranging complications for mother and newborn baby; Therefore, pain management in childbirth is very important. Different methods for analgesia during childbirth have been studied and evaluated, which are divided into two categories: pharmacological and non-pharmacological. Non-pharmacological methods can be effective only when labor pains are low, but since labor pains are very high, non-pharmacological analgesia can not be relied on. Drug methods include intramuscular injection of drugs, spinal anesthesia, epidural anesthesia, spinal-epidural anesthesia, remifentanil infusion and intermittent epidural analgesia. The most commonly used method is persistent epidural analgesia, but in cases where epidural catheter insertion is contraindicated for medical reasons, remifentanil infusion can be used.

One of the major complications surrounding surgery and anesthesia is cognitive dysfunctions that is necessary to know about important of complications and know the practical methods in perioperative and perianesthesia to reduce these complications. Inadequate accuracy and lack of awareness of the causes of these problems can be the main cause of these problems. The purpose of this article is to review the causes and factors that cause cognitive problems around surgery, in order to provide solutions to prevent their spread and emergence after surgery.

In this study, 61 appropriate articles related to this subject in terms of title that published between 1990 and 2020 on the causes of cognitive problems and prevention strategies were usedthat have been published in Jama،Science Direct،Google Scholar،Pubmed. Results and

In this review article the factors and preventive methods of cognitive dysfunctions were studied. These factors include: neuroprotectives, effect of anesthetic drugs, anticholinergic system, depth of anesthesia, pediatrics and emerging problems, sleep and circadian disorders, patient privacy, patient spirituality, blood sugar, electrolytes, hemoglobin, blood pressure, oxygenation and capnography, posture and position of patient, drug interactions, emboli, platelet activity, cardiac function, hypothermia and hyperthermia, pain and stress, delayed discharge, ileus and antibiotics.

Similar to industrial units, hospitals comprise of production factors including capital, human resource, technology and management. Successful performance of hospitals depends upon the way in which resources and in particular beds are allocated to patients. Thus it is necessary to implement an effective bed management so that on-demand healthcare services are accessible. In the same vein, hospitals need business intelligence tools to increase productivity, predict resource and equipment capacity and upgrade the healthcare service level so that they can achieve an effective bed management. Thus present research aimed to design a business intelligence model for bed allocation based on patient prioritization and allocation of equipment and services.

First the primary model was provided for bed allocation based on prioritization in a business intelligence concept framework. Then according to the conceptual model, required data were collected from various databases of neurosurgical intensive care units (ICUs) of Loqhman Hakim hospital by using ETL process and building data warehouse. In the next step, data mining classification algorithms were used to classify patients and develop prediction model. Then, patient classes were prioritized and simulation model was used to identify the effect of this prioritization. At last, the final model was provided.

The primary model for bed allocation based on prioritization in business intelligence concept framework was tested by data collection from 420 patients, data mining to classify them using decision tree technique with %87.02accuracy, prioritization of patient classes using PROMETHEE technique and simulation of 14 ICU beds based on collected data. Finally, it was estimated that the monthly number of hospitalized patients with and without prioritization were 76 and 86 respectively, Discussion and

After observing the positive results of the primary model for bed allocation based on prioritization including a 13 percent increase in monthly admission numbers and in turn, increased productivity proving model effectiveness, the next step was to develop a comprehensive business intelligence model for bed allocation based on prioritization of patients. The model was designed in business intelligence framework using online data collected from patients. The information provided by this model cAan be an effective decision making support for physicians and healthcare service providers in choosing patients in admission process.

The risk of heart ischemia after radiotherapy has not been determined precisely, and since myocardial ischemia jeopardizes the results of breast cancer treatment, we decided to increase the risk of heart ischemia after breast radiotherapy and the factors affecting in women candidates for general anesthesia for surgery.Materilas and

In this cross-sectional descriptive study, 209 patients referred to the operating room of Imam Reza Hospital in Tabriz with a history of radiotherapy by census method in the one year leading to September 2017 were included in the study. Demographic and Rose profile checklist (diagnosis of myocardial ischemia) was used for research purposes and the data were analyzed by logistic regression and Wilcoxon tests after entering SPSS21 software. P value less than 0.05 was considered significant.

Standard deviation; mean score of cardiac ischemia diagnostic index was 04.88 ± 0.93, of which 78 patients (37.33%) scored higher than 5 and 131 patients (62.67%) scored less than 5; seven potential ischemic related factors Patients at high risk for radiotherapy were identified as including age (OR=0.35, p=0.009), BMI (OR=0.38, p=0.007), and chemotherapy (OR=0.29, p = 0.005), tumor size (OR=0.45, p=0.005), tumor location (OR=0.09, p=0.02), tumor involvement side (OR=0.33, p=0.003)Number of radiotherapy sessions (OR=0.60, p=0.001).

Radiotherapy for the treatment of breast cancer as a risk factor for cardiac ischemia in women is a candidate for general anesthesia for surgery, which is exacerbated by factors such as age, body mass index, chemotherapy, tumor size and location, side involved and the number of radiotherapy sessions.