Influence of weather and air pollution on the occurrence of idiopathic pulmonary embolism in the region of Sousse (Tunisia).

Pulmonary embolism (PE) is the most serious manifestation of thromboembolic conditions. Its incidence varies considerably between countries, suggesting its interaction with the external environment. To analyze the influence of climate and air pollution on the occurrence of idiopathic PE in the region of Sousse (Tunisia). A total of 142 patients with idiopathic PE at two academic hospitals in Sousse (Tunisia) were enrolled in the study over a 7-year period. An analysis of two time series (environmental data and PE cases) was performed. Climatic data were collected from the National Institute of Meteorology. Air pollution data were obtained from the modeling platform of the National Agency for Protection of the Environment. The year 2015 was marked by the occurrence of the highest number of cases (24.6%). A statistically significant decrease in PE risk of 41.9% was observed during the summer with an OR of 0.59 (95% CI [0.36-0.94] and p = 0.026), compared with other seasons. Poisson GLM regression showed a significant increased risk of PE of 3.3% for each 1 °C temperature drop. After multiple binary logistic regression, the elevation of PM10 concentration was independently associated with an increased risk of PE (p < 10-3, OR 79.55, 95% CI [42.28-149.6]). Some environmental parameters may predispose to the onset of idiopathic PE. Understanding their accurate influence may have preventive and curative implications.

Chronic Pain following Chest Trauma: Prevalence, Associated Factors, and Psychosocial Impact.

Background: Chronic pain (CP) is a real public health concern. It is a common cause of poor quality of life and workplace absenteeism. It is well studied in many medical and surgical fields. However, only few data are available as regards to its occurrence in trauma patients. Purpose: To assess the prevalence, associated factors, and psychosocial impact of CP following chest trauma. Methods: This is an observational, descriptive, and analytic cross-sectional study performed in a Tunisian department of anesthesia and intensive care over a two-month period. Adult patients admitted one year ago for isolated chest trauma were enrolled. Data were collected by a phone interview. Studied variables were sociodemographic characteristics, traumatic injuries and their management, the occurrence of CP, and its psychosocial impact. CP was diagnosed by the Brief Pain Inventory (BPI) considering an evolution period of at least 3 months. Its impact was assessed by the BPI and the Posttraumatic stress disorder Checklist Scale (PCLS). Results: Fifty-four patients were included in the study. The prevalence of CP was 79.6%. The average CP intensity was 3.18 ± 1.4. It was neuropathic in 90.7%. Its main associated factors were pleural effusion (p=0.016), time to ICU admission (p=0.016), time to ICU admission (p=0.016), time to ICU admission (p=0.016), time to ICU admission (. Conclusion: CP following chest trauma is frequent and severe requiring preventive measures such as high risk patients screening, better management of acute pain, and a multidisciplinary approach for patients with diagnosed CP.

Assessment of the operating room efficiency by the real time of room occupancy.

BACKGROUND: The operating room is the most cost consuming area of hospitals. However, it still suffers from a non-optimized organization. AIM: To evaluate the performance of our operating rooms by the real room occupancy time (RROT), to identify the main causes of its alteration and to analyze the problem of deprogramming. METHODS: This is an observational and descriptive study conducted in two operating rooms in Sahloul teaching Hospital during August 2016. For the two studied rooms, a pre-established data sheet was filled during the days of scheduled activity. Collected parameters were  total RROT,  different periods of RROT, room occupancy rate, room overflow rate, incidence and causes of non-compliance with the surgical program and causes of RROT alteration. RESULTS:   The mean start time of the activity was 41.93 min/day. The mean overflow time was 11.51 min/day. The RROT was 246.56 min/day, corresponding to an average occupancy rate of 68.49%. On average 1.86 acts were performed per room and per morning with a total of 86 interventions. The deprogramming problem was noted in 38 cases. Its main causes were the overshoot of the vacation time offered to surgeons (36.84%), the emergencies (18.42%) and the non-respect of the anesthesia instructions (15.78%). CONCLUSION: The occupancy rate in our structures is relatively acceptable but should not hide the need to optimize the use of available resources. Corrective actions focusing primarily on delayed start-up and periodic reassessments are essential.

Intravenous lidocaine as adjuvant to general anesthesia in renal surgery.

The role of intraoperative intravenous lidocaine infusion has been previously evaluated for pain relief, inflammatory response, and post-operative recovery, particularly in abdominal surgery. The present study is a randomized double-blinded trial in which we evaluated whether IV lidocaine infusion reduces isoflurane requirement, intraoperative remifentanil consumption and time to post-operative recovery in non-laparoscopic renal surgery. Sixty patients scheduled to undergo elective non-laparoscopic renal surgery under general anesthesia were enrolled to receive either systemic lidocaine infusion (group L: bolus 1.5 mg/kg followed by a continuous infusion at the rate of 2 mg/kg/hr until skin closure) or normal saline (0.9% NaCl solution) (Group C). The depth of anesthesia was monitored using the Bispectral Index Scale (BIS), which is based on measurement of the patient's cerebral electrical activity. Primary outcome of the study was End-tidal of isoflurane concentration (Et-Iso) at BIS values of 40-60. Secondary outcomes include remifentanil consumption during the operation and time to extubation. Et-Iso was significantly lower in group L than in group C (0.63% ± 0.10% vs 0.92% ± 0.11%, p < 10-3). Mean remifentanil consumption of was significantly lower in group L than in group C (0.13 ± 0.04 µg/kg/min vs 0.18 ± 0.04 µg/kg/min, p < 10-3). Thus, IV lidocaine infusion permits a reduction of 31% in isoflurane concentration requirement and 27% in the intraoperative remifentanil need. In addition, recovery from anesthesia and extubation time was shorter in group L (5.8 ± 1.8 min vs 7.9 ± 2.0 min, p < 10-3). By reducing significantly isoflurane and remifentanil requirements during renal surgery, intravenous lidocaine could provide effective strategy to limit volatile agent and intraoperative opioids consumption especially in low and middle income countries.

[Burnout prevalence in Tunisian anesthesia and intensive care units]. / Prévalence du burnout en milieu d'anesthésie réanimation dans le centre tunisien.

INTRODUCTION: burnout is a particular cause of concern in Anesthesia and Intensive Care Units. In addition to its socio-economic impact, it alters the quality of care and patients prognosis. This study aims to assess its prevalence among the staff members of the Tunisian Anesthesia and Intensive Care Units. METHODS: we conducted a multicenter cross-sectional study in the Anesthesia and Intensive Care Units of seven Tunisian University Hospitals. The study included the medical and paramedical staff who gave consent. The measuring instrument used was the Maslach burnout Inventory. RESULTS: the study included 283 staff members (72.19%). The average age of subjects was 40.2 ± 9.38 years, with a female predominance. Maslach scale revealed that 94.71% of the participants had burnout. The mean emotional exhaustion score, depersonalization score and professional achievement score were 28.65 ± 11.92; 8.62 ± 6.65 and 34.58 ± 8.07 respectively. High to moderate burn-out level were found in 13.3% and 26.2% of cases respectively. Burn-out effects were dominated by additive behaviors (52.65%) and suicidal ideations (4.59%). CONCLUSION: burnout is becoming more and more a tangible reality for the staff members of the Anesthesia and Intensive Care Units, engendering serious social and personal consequences.

Effects of music therapy under general anesthesia in patients undergoing abdominal surgery.

BACKGROUND: Music therapy, an innovative approach that has proven effectiveness in many medical conditions, seems beneficial also in managing surgical patients. The aim of this study is to evaluate its effects, under general anesthesia, on perioperative patient satisfaction, stress, pain, and awareness. METHODS: This is a prospective, randomized, double-blind study conducted in the operating theatre of visceral surgery at Sahloul Teaching Hospital over a period of 4 months. Patients aged more than 18 undergoing a scheduled surgery under general anesthesia were included. Patients undergoing urgent surgery or presenting hearing or cognitive disorders were excluded. Before induction, patients wore headphones linked to an MP3 player. They were randomly allocated into 2 groups: Group M (with music during surgery) and group C (without music). Hemodynamic parameters, quality of arousal, pain experienced, patient's satisfaction, and awareness incidence during anesthesia were recorded. RESULTS: One hundred and forty patients were included and allocated into 2 groups that were comparable in demographic characteristics, surgical intervention type and anesthesia duration. Comparison of these two groups regarding the hemodynamic profile found more stability in group M for systolic arterial blood pressure. A calm recovery was more often noted in group M (77.1% versus 44%, p < 10-3). The average Visual Analog Scale (VAS) score was lower in the intervention group (33.8 ± 13.63 versus 45.1 ± 16.2; p < 10-3). The satisfaction rate was significantly higher among the experimental group (81.4% versus 51.4%; p < 10-3). The incidence of intraoperative awareness was higher in group C (8 cases versus 3 cases) but the difference was not statistically significant. CONCLUSION: Music therapy is a non-pharmacological, inexpensive, and non-invasive technique that can significantly enhance patient satisfaction and decrease patients' embarrassing experiences related to perioperative stress, pain, and awareness.