Psychometric properties of the Persian version of the Anesthetic Trainee Theatre Educational Environment Measure (ATEEM).

Background: The quality improvement of medical education programs and the ongoing reform of the curriculum should be done in the light of clinical training fields and identifying the strengths and improving the weaknesses. Therefore, this study was conducted to evaluate the validity and reliability of ATEEM (Anesthetic Trainee Theatre Educational Environment Measure) questionnaire for assessing learning environment of anesthesiology residents in educational centers affiliated to 3 main medical schools in Tehran, Iran. Methods: This study was conducted on first to fourth year anesthesiology residents using a questionnaire. Validity (face, content, construct) and reliability of ATEEM questionnaire was investigated. Construct validity was measured by confirmatory factor analysis, stability of reliability by test-retest, and internal consistency by Cronbach's alpha. Results: A total of 156 questionnaires out of 190 were fully answered, returned by residents of anesthesiology, and analysis were performed (82% response rate; 44.5% male (n=69); 55.5% female (n=86)). The age range of respondents was 26 to 48 years. The mean total ATEEM score was 114.03 out of 160. Face and content validity of the questionnaire was approved. Content validity ratio (CVR) and content validity index (CVI) were 0.63 and 0.88, respectively. Fitness indices in confirmatory factor analysis were greater than 0.9, and RMSEA (root mean square error of approximation) index was less than 0.08 (0.07). This indicator measures the acceptability of fitness and it is an appropriate measurement model. The average reliability coefficient was 0.73 and the overall Cronbach's alpha coefficient was 0.959. Conclusion: The results of this study showed that the Persian version of the ATEEM questionnaire, with appropriate psychometric properties, can be used to evaluate the anesthetic trainee theatre learning environment used in hospitals.

Prevention of propofol injection pain with small-dose ketamine.

PURPOSE: Propofol is a popular i.v. anesthetic induction drug that causes pain when given i.v., the incidence of which is between 28%-90%. We plan to determine the optimal dose of ketamine in the prevention of propofol injection pain and compare it with lidocaine, the commonly proposed pre-treatment. METHODS: In a double-blind randomized study 500 Patients (ASA I, II) scheduled for elective strabismus surgery under general anesthesia were randomly allocated into five groups. After obtaining the informed consent., patients received normal saline (Group NS), lidocaine 1 mg x kg(-1) (Group L), and different doses of ketamine 50-75-100 microg x kg(-1) (Group K50-K75-K100 respectively), immediately before the injection of 2.5 mg.kg(-1) propofol. Each patient's pain scores were measured at five seconds intervals by a blinded anesthesiologist. Statistical analysis were made by SPSS vs 11.5. RESULTS: The incidence and intensity of pain in all study groups were significantly lower than placebo group (Group NS) (P < 0.005). Patients in the K100 Group had significantly lower incidence of pain and lower pain scores compared with the K50 and L Groups (P < 0.0001). There were no significant differences in hemodynamic parameters between groups. CONCLUSION: Administration of ketamine 100 microg x kg(-1) immediately before propofol injection is a safe and effective method in preventing propofol injection pain.

Fucosidosis and anesthesia.

Fucosidosis is a rare, autosomal recessive lysosomal storage disorder caused by a severe deficiency of a-L-fucosidase. Patients usually have some problems with glycoprotein storage in the brain and other organs, and some structural abnormalities that need special consideration in anesthesia. It has 2 types, the early onset or infantile, and the juvenile. Here we present an 8-year old girl with deformities in the maxillofacial region, with big tongue, small and retracted chin, saddle nose, and short neck that could not be extended, causing difficult intubation, and congenital cardiac problems requiring a special anesthetic strategy.

Ondansetron pretreatment reduces pain on injection of propofol.

UNLABELLED: To assess the effectiveness of ondansetron pretreatment in alleviating propofol injection pain, 135 patients were randomly assigned to one of following three groups. Group 1 who received up to 2 mL pretreatment 50 mg tramadol in the saline, group 2 cases who received up to 2 mL pretreatment 4 mg ondansetron in saline, and group 3 who received up to 2 mL solution saline. A 20 gauge cannula was placed into the largest vein on the dorsum of the hand. Tourniquet was closed to the arm above the cannula and inflates to 70 mmHg, and then drug was injected. After 20 seconds, the tourniquet deflated, and propofol 2mg/kg injected over 10 seconds and pain assessment was made. RESULTS: Tramadol and ondansetron significantly reduced the incidence and severity of propofol injection pain more than placebo (P=0.001). The efficacy of ondansetron in alleviating the pain on injection of propofol was no different from tramadol (P=0.330). Ondansetron pretreatment may be used to reduce the incidence of pain on injection of propofol, an advantage added to the useful prevention of postoperative nausea and vomiting.

The effect of thiopentone on severity and duration of succinylcholine-induced fasciculation.

BACKGROUND: Thiopentone has a protective effect as far as succinylcholine-induced myalgias are concerned; however, a few studies were done in the efficacy of thiopentone on fasciculation induced by succinylcholine. The purpose of this study was to determine the effects of thiopentone on onset, duration, and severity of fasciculation caused by succinylcholine injection. METHODS: Three hundred patients, in American Society of Anesthesiologists Physical Status Classification I and II, undergoing elective ocular surgery at Farabi Eye Hospital in 2003 were considered and divided into 2 groups who received intravenous succinylcholine immediately and 30 seconds after thiopentone injection, respectively. After premedication and induction of anesthesia, the severity and duration of fasciculations caused by succinylcholine were compared between the 2 groups. RESULTS: In the group using succinylcholine immediately after thiopentone injection, the onset of fasciculation was earlier (P = 0.0006), and duration of fasciculation was shorter (P = 0.0002) than the other group. In addition, moderate to severe fasciculation was found more in the group using succinylcholine 30 seconds after thiopentone injection (P = 0.038). CONCLUSIONS: Pretreatment with thiopentone immediately before succinylcholine administration can decrease the duration and severity of fasciculation more than thiopentone injection 30 seconds before succinylcholine administration.