فصلنامه آنستزیولوژی و مراقبتهای ویژه ایران
سال سی و ششم شماره 1 (پیاپی 85، بهار 1393)

Capnography, the measurement of CO2 in respiratory gases has become an integral part of anaesthesia monitoring. A decrease in end tidal CO2 is seen with a decrease in blood pressure and cardiac output if ventilation remains constant. Theaim of this study was to prospectively assess the effect of changes in the blood pressure (20% above or below from baseline) on arterial-to-end tidal carbon dioxide gradient [P(a-ET)CO2] and their relationship during general anesthesia for coronary artery bypass graft surgery.

Fifty patients undergoing coronary artery bypass graft surgery were selected. A standard anaesthetic procedure was followed for all cases. Systoloic and diastolic arterial blood pressure were recorded as baseline after induction ofgeneral anesthesia, 20% above or below from baseline was calculated in all patients. The end tidal (ET) CO2 and PaCO2 were recorded at basline arterial blood pressure and during 20% above or below from baseline.

A significant increase in P(a-ET)CO2 was noted from 20% above of baseline and baseline to 20% below of baseline. (4.1±3.3 vs. 6.4±4.7 vs. 7±3 respectively).The Pearson correlation coefficient was 0.5, 0.4 and 0.5 respectively. There was a significant correlation between PaCO2 andETCO2 in each of the three conditions. (p<0.001)

In conclusion, the clinical practice of predicting PaCO2 from ETCO2 must be tempered by recognition of the potential magnitude of P(a-ET) CO2 gradient, which is higher than normal during hypotension. Further investigations are recommended.

Tracheal stenosis is one of the known complications of endotracheal intubation and tracheostomy. In this study we evaluated the incidence of post intubation tracheal stenosis in patients admitted to general intensive care unit (GICU) of urmia emam hospital.

In this follow-up study intubated or tracheostomy's patients admitted to GICU at 2012 – 2013 were evaluated. Patients with GCS= 3, Brain death and those who expired were excluded. SPSS ver.18 soft was used for analysis.

Of 112 intubated or tracheostomy patients with mean age 49.61±21.54 included, 76.8% of them were intubated and 23.25% had tracheostomy,tracheal stenosis in 2 cases (1.8%) of 112 patients was seen, that’s one case after emergency intubation and another case was elective that followed after tracheostomy.With fisher exact test no significant difference between sex, kind of intubation, intubation or tracheostomy and tracheal stenosis was seen (pvalue>0.05). With chi- square test between age groups and under lying diseases and tracheal stenosis there wasn’t any significant difference (pvalue>0.05). On the other hand with T-test significant differences between size of endo tracheal tube or tracheostomy tube and trachteal stenosis were not found. (pvalue>0.05)

Despite appropriate use of tubes and tracheostomy sets and routinely measurement of intra – cuff pressure cuff in intensive care unit, tracheal stenosis was seen.

Nowaday intensive care units (ICU) received more attention because of their high cost for health care systems. Peresent study aimed to determine mortality rate and its risk factors in the hospitalized patients in ICUs of Shahid Bahonar hospital in Kerman.

This cross-sectional descriptive study performed during the three years period from April 2010 to March 2012 in the trauma ICUs. All of patients who were dead in this period were entered to study. Factors such as age, gender, nosocomial infection, APACHE score, time of death (hours and days) and the number of transfused packed RBCs collected. Data were analized with use of suitabletest in SPSS18 software.

Totally 1112 patients were admitted to ICUs in three year. Of them 873 were men (78.5%) and the rest were women. In total 192 patients (17.26%) were died. Most of patients (28.28%) who were died have more than 60 years old (p<0.05).among patients who died in ICUs, 67.7% of them had APACHE score more than 25 (p<0.05). About 53.1% of deaths had occurred in the weekend and 64% has occurred between midnight to 6 am (p<0.05). Bacterial cultures results show that 22.9%of discharge patients and 24.3% of died patients were infectious and had at least one positive bacterial cultures during hospitalization (p>0.05). Statistically, 59.6% of the deceased had received more than 6 units of packed RBCs during hospitalization (p<0.05).

According to the findings, most risk factors that increase mortality in ICUs are preventable. So for decrease rate of mortality, health care team members in ICUs should pay more attentions to these risk factors.

Effective postoperative pain management is one of the anesthesia goals and there are benefits for rapid recovery and discharge from hospital. The aim of this study was to compare the effect of sublingual buprenorphine versus intravenous morphine on duration and severity of analgesia effects in patients undergoing inguinal herniorrhaphy.

During a single blind clinical trial, 80 patients ASA class 1 have been candidate for elective inguinal herniorrhaphy under spinal anesthesia were randomly divided into two groups equal. At the start of the surgery, one group was treated with sublingual buprenorphine (tablets 0.4 mg) and another group was treated with intravenous morphine (0.1 mg/kg). Patients were observed at the multi hours aftersurgery to record the time of pain onset and pain severity based on visual analog scale (VAS).

There was no significant difference between he mean ages of patients (p＞0.05). Comparison of ain onset during the first six hours after surgery and efore receiving the second dose of these drugs was howed a significant difference on increasing the uration of analgesia by the use of sublingual uprenorphine (p=0.001). The severity of pain during he 24 hours after surgery were lesser in sublingual uprenorphine group than IV morphine (p=0.001).

The result of this study showed sublingual uprenorphine is more effective than intravenous orphine in controlling pain.

According to the previous theories based on the issue that anti-hypertensive drugs should be withdrawn before surgery, nowadays it is accepted that some drugs effectively control systemic blood pressure to assure its desirable therapeutic control. So in this study, the efficacy of angiotensin inhibitors before the CABG surgery onhemodynamic changes was surveyed.

In this research, 54 patients were selected from those hospitalized in the cardiac surgery ward of Ahvaz Golestan Hospital by random sampling. They were divided into two groups of 27 each. The first group did not use angiotensin inhibitor to control blood pressure but the second group consumed it. In these groups, the needed amount of vasoactive drug for the patients, the efficacy of angiotensin inhibitor on hypotension rate before, during, and after surgery, and the neededamount of vasopressor drugs were surveyed.

The two experiments and control groups did not have significant differences from the viewpoints of demographic characteristics such as age, sex, and weight, and hemodynamic changes of SaO2 and PR before, during, and after surgery.Nevertheless, they had significant differences from the viewpoints of changes in minimum and maximum blood pressures in different time sections.

Using angiotensin inhibitor drugs can effectively reduce the blood pressure before, during, and after CABG surgery in the patients of the experimental group compared to the control group.

Tramadol intoxication is one of the most common intoxications in Iran. In this cross sectional study, we want to evaluate of the clinical findings and complications of Tramadol intoxication in patients referred to Urmia Ayatollah Taleghanihospital at 2012-2013.

After an approval from the ethic committee, total patients with tramadol intoxication if had inclusion criteria, were included in the study and clinical situation, recovery, complications and etc recorded and then analyzed with SPSS 17 Software, p-value<0.05 was significant.

In this study 233 patients were included. No correlation between the sex and complicaltions of tramadol but between marriage and convulsion (p-value= 0.04) and gait impairment (p-value= 0.002) were significant. On the other hand betweenthe time of use of drug and elevation of heart rate (p-value= 0.04) had correlation and elevation of the hear rate in 12-24 hour after the use of drug was seen. Between the history of the use of tramadol and convulsion (p.value = 0.01) also had correlation too.

The most use of tramadol to happened in 20-40 years old and in men compared women. The greater percentage of patients in this study had intermittent use of the drug. Nausea and vomiting were the most common gastrointestinal complications. As most of the patients were admitted. 79.8% weredischarged. The time of referral to hospital could be an influencing factor in outcome. Further studies are recommended.

Cardiopulmonary resuscitation is a basic process to deal with cardiopulmonary arrest. The most important skill of medical staff in preserving the life of patients is CPR. Because without resuscitation, brain death occurr following hypoxia in less than 4 to 6 minutes, cardio pulmonary resuscitation (CPR) is renamed to cardiopulmonary cerebral resuscitation (CPCR) due to the special importance of restoring and maintaining brain function. This study aimed to assess nurse's knowledge of Khoram abad city.

In this descriptiveanalytical study, 160 nurses in teaching hospitals of Khorramabad were enrolled. The data collection tool was a two-part questionnaire. Nurse's awareness was assessed by questionnaire in four excellent, good,average and poor levels. Finally the data using SPSS software version 16 and descriptive and analytical statistics were analyzed.

A total of 160 nurses aged 22-50 with a mean age of 29/2 years old participated in the study. 25.6% were male and 74.4% female. The mean and standard deviation of nurse's awareness was 23/3±5/6 with a range of 6-37. 7.5% of nurses having a high level of knowledge, 64.4% as good, 26.3% moderate and 1.3% as weak. Nurse's knowledge about the use of Combitube tube and LMA was not satisfactory.Discussion and

The results of this study show that nurses in the hospital should be provided education and trained in PCR, in the principles of continuation and cessation of CPR, the use of LMA, Combitubes, shock therapy, the use of AED, intra osseous injection and induced hypothermia.

Bleeding during functional endoscopy sinus surgery (FESS) remains a challenge for both surgeons and anesthesiologists. Although major blood loss during FESS is rare, maintaining an optimal surgical field is crucial for the surgeon; evena small amount of blood may disturbte endoscopic view, increasing the likelihood of complications, lengthening the operative procedure, and possibly resulting in incomplete surgery. The aim of this study was finding scientific evidence for intra venus tranexamic acid efficacy on bleeding rate in patients underwent endoscopic sinus surgery.

In this study, 66 patients 16-40 years underwent endoscopic sinus surgery divided to two groups, each 33 cases. One group were under general anesthesia with IV tranexamic acid and the other were control group. The mean of bleeding, mean arterial pressure during surgery and duration of surgery was assessed and data was analyzed with SPSS16 program.

The mean age of case and control group was 30.78±5.67 and 30.69±7.56 years. There was significant difference between two groups about bleeding rate (p=0.002) and mean arterial pressure (p=0.001).

According to this finding, it is thought the using intra venus tranexamic acid is useful for bleeding reduction during endoscopic sinus surgery.

Rhabdomyolysis and secondary acute kidney injury caused by myoglobin – induced acutetubular necrosis is a rare but serious complication of incorrect position. Obesity andprolongation of surgery are the most important risk factor of rhabdomyolysis. In this case we discuss a 80 years old man complicated after TURP in standard lithotomy position. raise in BUN, Cr, and CPK was happened in second day after surgery. The patient has been diagnosed as rhabdomyolysis and treated conservatively there is no need to dialysis and finally discharged from hospital in fifth day after surgery.