Vol 2 No 4 (2016): Autumn
Background: We investigated the effects of cigarette smoking in non-per os (NPO) period on volume and pH of gastric contents in smoker male patients.
Methods: In a prospective cohort study, 86 male smoker patients undergoing elective non-abdominal surgery under general anesthesia, were surveyed. They were NPO for at least 8-12 hrs. prior to surgery without direction to smoking. Then they were divided in two groups in the operation room based on smoking during NPO period. The study was continued until 43 patients entered in each group. After induction of anesthesia, gastric contents were aspirated by NG tube then volume and pH of gastric contents were measured. There were no significant differences in basic characteristics of patients such as age and weight between two groups.
Results: The pH of gastric content was significantly lower in the smokers group (1.57±0.74 vs 3.12±1.90 p=0.001). The mean volume was significantly higher in the smokers’ group (34.60±20.90 vs 19.86±14.72 ml, p=0.001).
Conclusion: Smoking during NPO period in habitual smokers before elective surgery increases the volume and acidity of gastric contents and probably increases risk of acid pulmonary aspiration.
The Effect of Single Dose of Harpagophytum Capsule (Teltonal) on Post Tracheal Intubation Sore Throat after General Anesthesia
Background: Sore throat is one of the major complications of tracheal intubation after general anesthesia. Harpagophytum is an herbal medicine, the anti-inflammatory and analgesic effects of which have been demonstrated in various studies. We studied the effects of single dose Harpagophytum one hour before tracheal intubation, to prevent the sore throat after extubation.
Methods: In a randomized clinical trial, 60 patients who had undergone general and urologic surgeries at Imam Reza hospital in Tabriz, Iran, since March to July 2015 that required tracheal intubation, were included in the study. The patients were randomly divided into two groups (case group 30 patients and control group 30 patients). In the case group, one hour before anesthesia, one Teltonal capsule (480 mg) was given to the patients. For the control group of patients, the empty capsule of Teltonal was given. After patients regained consciousness, the severity of sore throat was scaled and recorded by VAS scale after 2, 6 and 24 hours of the surgery.
Results: Severity and incidence of sore throat after tracheal intubation were not significantly different between case and control groups. Also, no side effects of Harpagophytum were observed in the case group.
Conclusion: Administration of Harpagophytum with the single dose of 480 mg one hour before the anesthesia and intubation did not decrease the sore throat severity and incidence.
Evaluation of Prophylactic Injection of Two Doses of Tramadol on the Heart Rate and Blood Pressure Changes after Laryngoscopy and Tracheal Intubation
Background: Laryngoscopy is an invasive technique that is associated with severe cardiovascular complications. This study was designed to compare the preventing effect of two doses tramadol injection on the heart rate and blood pressure changes after laryngoscopy and tracheal intubation in elective surgical patients.
Methods: In this clinical trial study, 189 elective surgical patients randomly divided to three groups: Group A and Group B, received tramadol 1mg/kg, 2mg/kg iv 5 minutes before induction of anesthesia respectively; Group C, received normal saline. The heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP) and mean arterial pressure(MAP) were measured just before induction of anesthesia, just before laryngoscopy, at 1, 3, 5, 10 minutes after laryngoscopy and tracheal intubation.
Results: Mean HR, SBP, DBP and MAP changes at 1, 3, 5, 10 minutes after laryngoscopy was significantly less in Group B, compared with Group A and Group C(P<0.05). The incidence of tachycardia (6.3% vs. 19% and 28.6% respectively) and hypertension (4.8% vs. 15.9% and 22.2% respectively) was significantly less in Group B compared with Group A and C (P < 0.05).
Conclusion: Administration of tramadol with dosage of 2mg/kg iv 5 minutes before induction of anesthesia, significantly attenuated blood pressure and heart rate changes till 10 minutes after laryngoscopy and endotracheal intubation compared with using tramadol 1mg/kg iv.
Evaluating the Relationship between Emotional Quotient (EQ) and Clinical Practice of Anesthesiology Residents with Type D and Non-D Personality
Background: The aim of this research was to determine and compare emotional quotient and clinical performance in type D and Non-D personality anesthesiology residents.
Methods: This was a causative–comparative research consenting anesthesiology residents (n=48). All the participants completed Bar-on emotional quotient and DS-14 (Type D personality) questionnaires. Clinical performance of participants was evaluated by faculty with GRF (Global Rating Format), DOPS (Direct Observation of Procedural Skills) and OSCE (Objectively Structured Clinical Examination) scores. For evaluating research hypothesis, data were analysed with single and multivarient analysis of variance.
Results: Regarding the results of present study, the difference between emotional quotient and clinical performance scores between type D and non-D anesthesiology residents was statistically meaningful. Only in social responsibility subscale, there was no statistically difference between two groups.
Conclusion: Research results demonstrated that emotional quotient and clinical performance was lower in type D personality anesthesiology residents comparing to non-D.
Effect of Intra-Abdominal Pressure on Post-Operative Discharge Criteria in Laparascopic Cholecystectomy
Background: Pneumoperitoneum results in respiratory and hemodynamic changes. It is unknown whether hemodynamic changes that last to the recovery room could change recovery criteria.To determine the effect of decrease in intra-abdominal pressure on discharge criteria after laparascopic cholecystectomy.
Methods: Patients with age 25-65 who were candidated for elective laparascopy cholecystectomy were enrolled in the study. In high pressure group, intra-abdominal pressure was maintained at 12, and in low pressure group at 8 mmHg. Intra-abdominal insufflation was performed using CO2. After surgery, patients were transferred to recovery room. Heart rate, blood pressure, and pulse oxymetery monitoring were continued in recovery room and modified Aldrete scores were measured every 4 minutes. Patients were discharged from recovery if they had Aldrete score> 9.
Results: Aldrete scores were lower in high pressure group compared to low pressure group at 4 and 8 minutes in recovery room, however this difference was not significant (p=0.17, 0.44; respectively). At 12, 16, 20 and 24 minutes Aldrete scores were not significantly different between two groups (p> 0.05).
Conclusion: The effect of decreasing intraabdominal pressure from 12 to 8 mmHg during insufflations of CO2 in laparascopy induces only minor non-significant decrease in discharge time and criteria.
One of the more infrequent congenital diseases with a wide spectrum of symptoms and more complications of the right side of pulmonary artery (63% according to Ten Harkel) is unilateral pulmonary artery agenesis (UPAA). The clinical presentation is variable, and many patients can be asymptomatic for many years and even throughout their lives. Although the disease more frequently appears in childhood with moderate to severe respiratory symptoms, some patients continue living with the disease up to adulthood. The abnormality is sometimes concurrent with cardiac anomalies. Patients with UAPA may be asymptomatic or may present with recurrent pulmonary infections. In a report, a 25-year old woman who had inductional termination of pregnancy at 35 week last menstrual period (LMP) in a rural hospital due to preeclampsia reported as the UAPA patient.
Bradycardia and Severe Bispectral Index Drop Following Femoral Nerve Block by Dexmedetomidine due to Accidental Vascular Puncture: A Case Report
A 25-year-old Afghan male was presented to the emergency department with femoral shaft fracture following fall from the height. The patient was subjected to femoral nerve block and general anesthesia. First try for performing nerve block led to vascular puncture. Therefore, the needle was removed and re-inserted 1 cm lateral to first puncture site and DEX injected slowly with aspiration check after every 5 mL to avoid intravascular injection. Immediately after injection, heart rate dropped to 40, blood pressure decreased to 85/50 mmHg and the BIS dropped to 30. Because of not spontaneous resolving the situation atropine and ephedrine were ordered that resulted to regain hemodynamic stability.
It is likely that vascular puncture during peripheral nerve block can lead to some adverse events that need to be monitored precisely.