فصلنامه آنستزیولوژی و مراقبتهای ویژه ایران
سال سی و ششم شماره 2 (پیاپی 86، تابستان 1393)

General anesthesia is usually required to insert an endotracheal tube into the trachea. In some patients or some conditions intubation is difficult and requires the use of assistive devices by an expert. Investigator of this study used his experience to make a flexible tracheal tube from P.V.C. which was easy to use. This study aimed to compare the complications of endotracheal intubation with common tracheal tube and flexible tube made by the researcher in this study.

This research was a clinical trial study. A total of 128 patients candidate for elective general anesthesia were randomly assigned to intubate with common PVC tubes (n=53) or flexible tubes (n=76). The induction of anesthesia was similar for all the patients. Data were analyzed with SPSS software and P<0.05 was significant.

There was no sore throat in 39 (%73/6) participants in control group and 55 (%72/6) subjects in study group; no significant difference was observed between the two groups (p=0.433). Furthermore no significant difference was detected between groups regarding the incidence of cough. 42 patients (%79/2) of the control group and 69 patients (%90/8) of study group didn’t have cough at different evaluation times after operation (p=0.272). Neither of subjects developed hoarseness.Conclousions: The tracheal tube designed by the researcher, in terms of performance efficiency and complications, is comparable with foreign available brands in the market. Besides it is more economic, easier to use and does not require accessory device.

Malnutrition is a common problem among patients admitted to intensive care units. Nutrition support in intensive care units (ICUs) is accepted as an integral part of patient care; however, feeding remains a low priority compared with other ICU treatments. At present there is little information describing the enteral feeding perception of critical care nurses so this research tried to investigate nurses’ perception about NGT feeding in intensive care unit of city of Kerman medical university’s hospitals in 2013.

This research was a descriptive and cross-sectional study. Participants were 119 nurses whom worked in Kerman medical university’s hospitals and did not do sampling. The instrument for data collection was a researcher – made questioaire and included two parts: first part included 10 questions about demographic characteristics, second part included 14 scenario for survey nurses’ perception about tube. Descriptive statistics and t-test, ANOVA and Pearson correlation were index used for data analysis with software SPSS 18.

In this study, we found that 92.4% of the subjects were women, and 80.7% of them were married and 96.6% of them had a bachelor's degree in nursing. Mean score of perception was 6.68 ±1.99 out of 14. Highest score of nurse's perceptions was related to prevention of tubal obstruction and infection. So although there was a positive perception but it was less than the average, as well as there were significant difference between perception and overtime.

The result of this study showed that score of Nurse's perception was less than half (47.7 % overall score). It is recommended that Evidencebased standards and guidelines should be taught to nurses in intensive care units to gain more awareness and positive perception and feeling more capable, thus taking more principled action during enteral nutrition.

Lack of adequate pain control after laparoscopic cholecystectomy is of displeasure and delays post-operative discharge. Considering the systemic side effects of opioids, several techniques including thoracic epidural or intraperitoneal analgesia are used as an alternative to control postop pain. In this study we compare the analgesic effects of single dose intraperitoneal bupivacaine plus fentanyl to single dose of thoracic epidural as two different analgesic techniques in laparoscopic cholecystectomy.

In a randomized clinical trial, 52 ASA class I, II patients between 18 to 68 candidate for laparoscopic cholecystectomy were divided into intraperitoneal (I) and thoracic epidural (T) groups. In (I) group, before Trocar removal, 80 ml of 0.125% Bupivacaine plus 50 microgram fentanyl and 1/200000 epinephrine were injected intraperitoneally via infra umbilical incision site. In (T) group 15 ml of 0.125% bupivacaine plus 50 microgram fentanyl and 1/200000 epinephrine wereinjected through epidural thoracic space. Pain at thetime of discharge from recovery room and within 6,12 and 24 hours after surgery, using visual analog scale (VAS) were evaluated and the first time of analgesic need with VAS>3 were recorded and compared. Total morphine consumption in recovery room and within 24 hours post-operative were recorded and compared. Moreover, hemodynamic parameters and postop nausea and vomiting were assessed.

Effects of postop analgesia and time to first analgesic requirement in intraperitoneal and thoracic epidural groups were not statistically different (p values> 0.05).

Both intraperitoneal and thoracic epidural analgesia are effective techniques in post laparoscopic cholecystectomy pain control, which are applicable according to patient’s condition.

Pediatric patients are unable to express their pain by words therefore we should properly manage this topic. NSAIDs and opioids have side effects therefore intravenous paracetamol with fewer side effects has been advocated recently. We aimed to compare the analgesic effect of paracetamol with meperidine in pediatric patients scheduled for unilateral hernioraphy.

Eighty patients were randomly allocated in two groups (paracetamol and meperidine). Both groups received a same anesthesia protocol. Paracetamol 15 mg/kg and meperidine 1mg/kg were intravenously injected at the beginning of surgery. Analgesia was assessed by OPS criteria postoperatively for 6 hours. Those with higher scores received morphine rescue therapy and were excluded. Pain scores and those who required morphine were compared in the two groups.

Age and gender were not statistically different between groups (3.1±4.8 yr in paracetamol and 2.9±4.6 in meperidine group; p=0.85. Male to female ratio was 57.5/42.5 in both groups). Pain score was not statistically different in recovery and the first hour postoperatively, however scores were higher in paracetamol group thereafter. More patients required morphine as rescue therapy in paracetamol group compared to Meperidine (10, 3, 9, 15 and 3 patients in paracetamol group received morphine from the second hour until 6th hour postoperative in ward, while 7 patien in Meperidine group received rescue therapy in their 6th hour postoperative in ward).

Intravenous Meperidine reduced postoperative pain more effectively than paracetamol in pediatric patients undergoing unilateral hernioraphy.

Bleeding during functional endoscopic sinus surgery (FESS) remains a challenge for both surgeons and anesthesiologists despite several modalities available for improving the surgical field. In spite of demonstrated favorable effects of Tranexamic acid (TA) on bleeding tendency in cardiac, major orthopedic, transplantation and prostate surgeries, Its IV use in FESS has never been examined. This study was conducted to evaluate the efficacy of intravenous TA in improving the surgical field in FESS.

In placebo-controlled clinical trial a total of 88 ASA physical status I-II patients, aged 15-66 years, undergoing endoscopic sinus surgery under general anesthesia were allocated based randomly table number, to receive either intravenous TA 15mg/kg or sterile water 200 cc as a bolus dose immediately before induction of anesthesia. Anesthesia and surgery protocols were the same in both groups. Bleeding and satisfaction scores were obtained from the surgeon and his aid and compared between two groups.

In view of the surgeon, the median (range) bleeding scores in the TA group was 98.41 (51.35) and in placebo group was 148.98 (71.75) (pvalue= 0.01). Accordingly the surgeon was more satisfied with the surgical field in the TA group than placebo group.

Intravenous TA can not clinically reduce bleeding during FESS.

Percutaneous subclavian vein catheterization is one of the most common invasive procedures performed in cardiac surgery. The aim of this study was to compare left and right subclavian vein catheter placement via the infraclavicular approach in patients undergoing coronary artery bypass graft surgery.

This prospective, randomized clinical trial was performed in 193 patients. The technique of cannulation was the same for both the right and the left sides included infraclavicular approach. If catheterization of the subclavian vein was unsuccessful after 2 attempts,the other side subclavian vein was attempted. The success and complication rates were compared in both sides.

In 193 patients, catheterization attempts were performed, in whom 177catheterizations (91.7%) were successful during the first attempt, 105 (92.1%) on the right side and 72 (91.1%) on the left side. There were no significant differences between success rate and side of catheterization. Malposition of the catheter tip on the right side (9.6%) was significantly more(p =0.003) than the left side (0%). There were no significant differences between the incidence of the other complications on the two sides.

Compared with the right side, insertion of the cannula on the left side resulted fewer catheter tip misplacements although both sides showed the same incidence of cannulation failures and other complications.

The incidence of fentanyl-induced cough (FIC) during induction of general anesthesia varies from 28-65% and is undesirable. It increases intracranial, intraocular and intra-abdominal pressures. This prospective, randomized, doubleblind, placebo-controlled study evaluated the effect of propofol and magnesium sulfate pretreatment on the incidence and severity of FIC.

312 ASA class 1-2 patients, aged 18-60 years, scheduled for orthopedic elective surgery, were randomly allocated into three groups (n=104 for each). Group 1 received 30 mg/kg magnesium sulfate (5 ml), group 2 received 0.3 mg/kg propofol (5 ml), and group 3 received 5 ml normal saline 1 min before administration of 2 μg/kg fentanyl. The incidence, severity and the onset time of cough were recorded for 1 min after fentanyl administration. P value<0.05 was significant.

The incidence of FIC was 12.5%, 9.6% and 33.7% in groups 1, 2, 3, respectively (P<0.05 for treatment groups 1 and 2 versus control group 3). There was no significant differences in the severity or onset time of cough among the three groups.

Intravenous magnesium sulfate (30 mg/kg) and propofol (0.3 mg/kg) 1 min before the administration of intravenous fentanyl (2μg/kg) significantly reduced the incidence of FIC.

To assess the level of consciousness and prognosis in ICU is essential to have a standardized scale. Since many measures have been used to determine the level of consciousness. FOUR new scale is a measure that has been developed keeping in the limitations of the GCS which could be useful in intensive care unit. The purpose of this study was to measure the level of awareness of medical personnel in hospitals of Khorramabad in 2010 about FOUR.

Materials And Metods: 

This was a descriptive_cross_sectional study. A stratified random sampling method was conducted among nurses in teaching hospitals of Khorramabad, final volume of the sample was 90. The data gathering tool was a questionnaire containing demographic information and consists of 24 questions about knowledge and the criteria of FOUR score. After collection, the data were analyzed with SPSS_16 software and chi_ square tests and t tests were used.

A total of 90 patients with a mean age and age range of 23 to 50 13±7.28 years experience, 1 to 28 years with a mean of 6.8±7.75. 24.4% were male and 75.6% were female. The mean total scores was 5.9 ± 6.93, respectively. Knowledge of the subjects in this study, 60% as poor, 34.4% moderate and 5.6% as well. No significant difference between the knowledge of sex, degree of service, marital status and attendance of seminar was seen. etween the knowledge age, years of service in hospitals, there was no significant difference (p<0.05).

The results showed that awareness about FOUR standard is poor.

Laparoscopic surgery is the most common abdominal surgical procedures throughout the world. In addition to its numerous benefits, there are also significant complications. Subcutaneous emphysema as a complication of insufflation of carbon dioxide can be created blowing accidentally extraperitoneal during laparoscopic surgery. In this report, 34_year_old man with a history of hepatitis, who came to the operating room for a diagnostic laparoscopy surgery, developed subcutaneous at the end of surgery. The patient was immediately ventilated and with intubation transferred to the intensive care unit. The subcutaneous emphysema subsided during 24 hours and the patient was discharged without any complications after 24 hours.