فصلنامه آنستزیولوژی و مراقبتهای ویژه ایران
سال چهل و چهارم شماره 2 (پیاپی 114، تابستان 1400)

Fear of labor pain causes to lower rate of NVD and increased c/s. Entonox inhalation is an effective method for pain relief of NVD. Our goal is to investigate side effects of N2O on mother & fetus.

This Randomized clinical study has been done on 178 primiparous full term pregnant women, candidate for NVD. Entonox and oxygen were administrated for case and control group, respectively. Maternal age, gestational age, evidences of placental abruption before and after delivery, type of delivery, meconium passage, APGAR Score, symptoms such as nausea, vomiting, vertigo, dryness of mouth, drop in Hb level are investigated.

The mean pain score at the 1st to 5th hours in the Entonox group was significantly lower than the oxygen group (Pvalue <0.001). But at six hours after the intervention, the pain score in the Entonox group with a mean of 8.8± 0.9 was not significantly different from the oxygen group with a mean of 9.0 ± 0.9 (P value> 0.05). The incidence of hemoglobin loss in the oxygen group was significantly higher than the Entonox group (P value <0.001); but the two groups did not differ significantly in terms of decolonization during delivery, accelerated delivery, fetal meconium, Apgar scores of 1 and 5 minutes and type of delivery (P value> 0.05).

Use of Entonox for labor pain relief has small and not significant side effects on mother & fetus. Entonox caused lower levels of blood loss probably because of its useful effects on course of labor.

Postpartum depression is a mood disorder that depends on several factors and weakens the mother-child relationship, has a negative impact on mental health, quality of married life and family members. The aim of this study was to achieve postpartum depression and neonatal Apgar score in normal delivery with and without pain.

The method of the present study is quantitative and applied, using the method of correlation and structural equations. In terms of time, this study was conducted in the spring of 1400, and during this study, 120 women who referred to health centers in Qom who had passed one month to forty days after delivery were examined. The research instruments were Edinburgh Depression Inventory and Demographic Information. Spss-25 software was used for analysis and Smart Pls was used for path analysis.

The mean and standard deviation of depression in this sample was 12.7. 7.05. Moderate to moderate postpartum depression was reported. Neonatal Apgar score, neonatal sex, normal delivery with and without analgesia do not play a significant role in depression.

In order to prevent this disorder, it is recommended to implement educational and support programs for mothers and wives during pregnancy and after delivery, and to prevent the complications of this disorder by timely referral of mothers.

Acute stroke, just like heart attacks or trauma, is an emergency and should be treated urgently. The aim of this study was to evaluate the effectiveness of attendance of special stroke team on time interval between admission of patients with acute stroke to the emergency department and the start of thrombolytic treatment (Door to Needle) in patients with acute stroke.

This cross-sectional analytical study was performed on 250 patients with acute stroke, in two groups of 125 cases. Demographic information (age, sex, comorbidity, history of previous stroke) and related information including way of transferring to the hospital, time to visit the emergency medicine specialist, performing brain CT scan, neurologist visit, transfer to the stroke ward, obtaining consent, and time of initiation of thrombolytic therapy were collected, using a self- made questionnaire. Data collection in the intervention group was performed by a special stroke team, and in the control group by emergency department personnel. Results were compared and analyzed with statistical software.

No statistically significant difference was found between demographics of patients in two groups. However, time to visit the emergency medicine specialist, performing brain CT scan, neurologist visit, transferring to the stroke ward, obtaining consent, and time interval of admission and initiation of thrombolytic therapy (door to needle) were statistically different (P = 0.000).

Findings indicate that attendance of Stroke special team in the emergency department, reduces the time interval between admission and initiation of thrombolytic treatment in patinets with acute stroke which reduce further complications and decrease the burden of disease.

Background and Aim: The goal of triage is to classify and treat patients according to the severity of the injury based on five levels of priority. However, triage error may occur by allocating patients to lower (under-triage) or higher (over-triage) classes, leading to deterioration in patients' status or restricting access to patients in need for immediate care. The aim of this study was to evaluate the accuracy and outcomes of triage performed for patients in the ER of Shahid Beheshti Hospital (Qom, Iran). Materials and methods: In this retrospective cross-sectional study, 456 samples were randomly selected from medical records of patients admitted to the ER and triage form data and patient outcome were collected. The accuracy of triage was assessed by comparing the triages performed by the nurse with the standard triage of ESI. Data were analyzed using SPSS with a significance level of 0.05 Results: Out of 456 patients, 92.8% of patients were discharged, 5.7% were hospitalized and 1.5% of patients died. 76.1% of performed triages were correct, 5.7% were under-triage and 18.2% were over- triage. There was no significant correlation between patients' final outcome and triage accuracy. The most common reason for patients’ referral to ER was trauma (48%), in which the highest triage error had occurred. Reason for referral and the accuracy of triage were significantly correlated (p = 0.002) Conclusion: The most triage error was noted in the most common cause of patient referral (trauma). The rate of emergency triage error was 23.9% in the form of over-triage (18.2%). Although this triage error did not have dangerous outcomes for patients, it is recommended to improve the knowledge and skills of triage nurses in order to reduce errors.

Tramadol is a hydrochloride-structured synthetic narcotic drug with central effects and its intoxication severely involves the nervous system. Since it has recently reported to be one of the most common causes of drug intoxication in Iran, the present study aimed to investigate the frequency of its adverse effects and outcome in patients referred to the emergency department of Shahid Beheshti Hospital in Qom during 2018-2019.

Medical profiles of 180 eligible patients with acute tramadol intoxication were assessed. Demographics data, clinical findings (loss of consciousness; seizures; gastrointestinal, cardiac and respiratory symptoms) and patients’ outcomes (duration of hospitalization, ICU admission and death) were collected. Data analysis was performed by SPSS.22 and significance level were considered to be <0.05.

The most common adverse effect was gastrointestinal complications (37%), followed by seizures (34%), loss of consciousness (33%), cardiac complications (13%) and respiratory depression (7%). Consumption amount was also significantly correlated with gastrointestinal complications, loss of consciousness, duration of hospitalization and ICU admission. P<0.05

Central venous catheterization is an important procedure for children undergoing heart surgery. The aim of this study was to evaluate the effect of anatomical landmark technique by the Cardiac Anesthesia Fellowship after six months of training on internal jugular vein access in children under 6 years of age undergoing congenital heart surgery

A total of 70 children under 6 years of age who underwent heart surgery were prospectively analyzed with internal jugular vein catheterization. All catheterizations were performed by cardiac anesthesia fellowship assistants (who were trained for 6 months). Information including demographic characteristics, success rate, and catheter-related adverse events was recorded

The success rate of catheter placement in the right internal jugular vein in the first attempt was 68.5% (48 cases). The success rate in the second and more attempts was 21.5% (15 cases) and the failure rate (catheter insertion from another central femoral vein or subclavian vein) was 10% (7 cases). In the first successful attempt, the most uncomplicated cases were 48.5% (34 cases) and in the second and subsequent successful cases (maximum 4 times), arrhythmic complication was predominant and arterial puncture was observed in a total of 51.5% (36 cases) .