فصلنامه آنستزیولوژی و مراقبتهای ویژه ایران
سال چهل و چهارم شماره 1 (پیاپی 113، بهار 1400)

The aim of this study was to determine the effect of changes in respiration rate on the outcome of weaning from mechanical ventilation in patients admitted to the intensive care unit of Golestan Hospital in Ahvaz in 2020.

The present study was a cross-sectional and analytical study. The statistical population of the study was all patients under mechanical ventilation admitted to the intensive care unit of Golestan Hospital in Ahvaz from April to June 2020. The sample size in the present study was 135 people. SPSS 24.0 software was used for data analysis. The significance level for all tests was 0.05.

The highest frequency of the need for mechanical ventilation in the studied patients was postoperative, acute brain injury and respiratory distress. Based on the findings of the present study, a total of 52.6% of patients under mechanical ventilation had successful separation. The cut-off rate of respiration for successful separation from mechanical ventilation was RR > 20. According to the findings, for approximately 67% of patients with RR <20, the result of separation from mechanical ventilation was successful, and for 60% of patients with RR> 20, the result of separation was unsuccessful. Sensitivity and specificity were obtained by determining the cut-off RR > 20 equal to 70% and 60%. In other words, 70% of patients with unsuccessful separation resulted in RR> 20 and 60% of patients with successful outcome had RR <20.

Based on the results of the present study, the respiratory rate had a significant relationship with the result of weaning from mechanical ventilation. Patients with high respiratory rate have deliberately had the result of weaning from poor mechanical ventilation. Also, the sensitivity in the present study was obtained with a cut of RR> 20 times 70%. 60 percent of patients who had more than 20 breaths had a successful separation outcome.

Surgery and anesthesia cause a number of physiological disorders that affect the organs of the body and may appear as complications during recovery after anesthesia. Therefore, these cases must be evaluated and identified.

This is a descriptive-analytical epidemiological study designed on 385 patients transferred to the recovery ward of Imam Khomeini Hospital in Ahvaz who underwent general surgery during a 4-month study in 1399. Done. Patients from different age groups and genders were included in the study considering the inclusion and exclusion criteria. After attaching the monitors to the patients, first the basic vital signs including systolic and diastolic blood pressure, heart rate and blood oxygen saturation were measured and recorded in the information form.

In this study, the sex distribution of patients undergoing surgery in 57.66% were male and 42.34% were female. According to the results, 53.2% of patients underwent epidural anesthesia, 43.1% under general anesthesia, 1.6% under local anesthesia, 1.3% under block sedation and 0.8% under anesthesia bed. The most common complications observed in the operating room were pain, chills, and nausea, so that 40.52% of patients in the recovery room had pain, 19.5% had chills, and 16.4% had nausea. Other complications included changes in blood pressure (8.4%) and vomiting (1.6%).

The results of this study showed that the most common complications observed in the operating room were pain, chills and nausea. Also, these complications were more common in general anesthesia than epidural anesthesia, while in other anesthesia methods, no complications were observed during recovery.

In December 2019, a disease of unknown cause broke out in Wuhan and spread rapidly throughout the world. The disease was officially named -19 COVID by the World Health Organization (WHO). Recent evidence has shown that inflammation and hyperthyroidism play an important role in disease progression, especially in patients with severe involvement. Therefore, treatments that can reduce the inflammatory load or stop the cytokine production process are likely to be effective for patients with severe involvement. Therefore, in this study, we investigated the effect of dexamethasone in patients with coronary heart disease and hypoxemia . This study was performed as a clinical trial with a control group, with parallel groups, without blinding, phase 3. The study on the effect of dexamethasone for corona treatment in Shahid Beheshti and Forghani hospitals in Qom province was performed by reviewing the records of patients hospitalized with Covid-19 in March 1998 and April 1999 . This study was performed through random sampling method, block allocation. In this study, a number of patients who had received dexamethasone at a dose of 12 to 16 mg daily for at least 3 days were randomly selected and another group of patients with coronary artery disease in terms of underlying disease, sex, age and severity were selected. Pulmonary involvement was almost identical and the results were evaluated .

According to the results and considering the results of damping outcomes, disease severity and length of hospital stay after treatment, 28.9% died in the intervention group and 49.4% in the control group. The difference was significant. (pv = 0.04) In terms of length of hospital stay and mean hospital stay in the intervention group was significantly higher than the control group. (pv = 0.00)

Based on the results of this study, the use of corticosteroid drugs in the treatment of these patients is effective in controlling the disease process and reducing its severity .

Gastrointestinal endoscopy is an essential method for evaluating and treating gastrointestinal disorders. Sedation in endoscopy aims to safely and effectively control pain and anxiety, to provide an appropriate degree of amnesia or to reduce consciousness, and to improve endoscopy, especially in medical cases,always been a critical issue. Propofol is an effective sedative but does not cause adequate analgesia. To overcome the side effects of lidocaine and ketamine in different doses has been used to increase anxiety, sedation and recovery, but different results have been obtained from different studies. Therefore, the aim of this study was to compare the sedative effect of propofol-ketamine with propofol-ketamine with lidocaine spray in endoscopy.

A clinical trial study was performed on 144 patients who were candidates for outpatient endoscopy in the endoscopy ward of Imam Khomeini Hospital and the patients were randomly divided into two groups. After taking the patient's history, in the first group 0.5 kg / mg propofol with 0.5 kg / mg ketamine and in the second groupin the second group, 2 puffs of 10% lidocaine spray equal to 20 mg were sprayed on the oropharynx. Then 0.5 mg / kg propofol and 0.5 mg / kg ketamine were injected. Then sedation, apnea, nausea and clinical findings in patients were evaluated and compared.

In this study, the sex distribution of patients undergoing surgery was 46.75% female and 53.25% male. In this study, the mean age of patients was 49.40 years and the two groups were matched for age and gender. The mean duration of anesthesia was 15.84 minutes and the mean endoscopic duration of patients was 13.34 minutes. There was no significant difference between the distribution of anesthesia duration and endoscopic duration in the two groups. According to the study, sedation was higher among patients receiving propofol, ketamine, and lidocaine spray.There is no significant difference in systolic blood pressure levels between the two groups. Heart rate was significantly lower during the duration of anesthesia in the propofol, ketamine, and lidocaine groups. Blood oxygen levels were significantly higher in the propofol, ketamine and lidocaine group. There is no significant difference between apnea and nausea in patients in the two groups and the recovery time in patients receiving propofol and ketamine and lidocaine is longer than the propofol and ketamine groups.

Adding topical lidocaine spray to the propofol-ketamine drug combination for endoscopic procedures increases the degree of sedation in endoscopy.

Stability of hemodynamics and physiological parameter after open heart surgery is one of the most important reasons for success in surgery. Tracheal suctioning causes hemodynamics and physiological instability. Patients should be sedated after open heart surgery, so they need tracheal suctioning. Therefore, in this study we aimed to investigate the effect of carina anesthesia by topical administration of lidocaine in endotracheal suctioning on hemodynamic parameters and bucking in adult patients after heart surgery.

In a double-blind randomized clinical trial, adult patients undergoing coronary and valve surgery through the fall 2020 in Rajaie Cardiovascular Medical and Research Center were randomly assigned in two groups of 34 patients. Group A received tracheal suction with 4 cc of 2% lidocaine in intratracheally and group B received tracheal suction with 4 cc of 0.9% normal saline intratracheally. Changes in hemodynamic parameters (HR, CVP, MAP), bucking and Spo2, at 2 Minutes before, during and 2 minutes after suctioning were studied at intensive care unit (ICU). Data were analyzed using two-way repeated measures ANOVA.

There was a statistically significant difference between lidocaine group and normal saline group in all hemodynamic parameters and bucking during and 2 minutes after suctioning (p <0.05), but there was no statistically significant difference between the two groups in Spo2 (P>0.05).

According to the results of the study, it can be concluded that the use of intratracheal lidocaine during endotracheal suctioning in cardiac surgery patients reduces changes in hemodynamic parameters and bucking during and after endotracheal suctioning.

Endoscopy is one of the invasive medical methods for diagnosing gastrointestinal disorders that cause anxiety in patients. The aim of this study was to determine the effect of guided imagery on anxiety in patients undergoing endoscopy.

In this two-group clinical trial study, 60 endoscopic candidate patients referred to 22 Bahman Hospital in Gonabad were selected by convenience sampling and randomly divided into two groups of intervention (n = 30) and control (n = 30). At the beginning of the study, the Spielberger Anxiety Inventory and demographic Information, were completed. For patients in the intervention group, one hour before endoscopy, the guided imagery audio file was played through headphones for 20 minutes. The control group received only routine care .Immediately before the intervention, the anxiety questionnaire was completed again and the data were analyzed using SPSS 16 software and statistical tests.

The results of the study showed that there was no statistically significant difference between the intervention and control groups in terms of anxiety before the intervention (P> 0.05) but there was a significant difference after the intervention (P = 0.001). Also, the mean scores of hidden and obvious anxiety after the intervention in the intervention group was significantly reduced compared to the control group (P = 0.002).

Guided imagery reduces the anxiety of endoscopic candidate patients. Therefore, this non-pharmacological method can be used to reduce patients' anxiety before endoscopy.