[Comparison of plasma glucose level among traumatic patients in casualty and emergency department]

There are several studies about the correlation of blood glucose level and prognosis in traumatic patients. To determine the relationship between the on-admission plasma glucose [G] level with the type and severity of trauma. In this analytical study, 270 patients who were admitted to the trauma center of Alzahra general hospital in 2006, evaluated for plasma G level, GCS, TS, and the type of trauma upon admission. In cases with plasma G [BS1] grater than 140 mg/dl on admission, the plasma G [BS2] was re-checked the next 24 hours. Data were analyzed using t-test and correlation ratio. Findings: The incidence of different types of trauma and their mean BS1 were as follows: head and neck trauma [45%, BS1=238 +/- 104 mg/dl], multiple trauma [28%, BS1=193 +/- 82 mg/dl], extremities trauma [16.1%, BS1=140 +/- 12 mg/dl], abdominal and chest trauma [7.4%, BS1=200 +/- 89 mg/dl], and pelvis trauma [2%, BS1= 152 +/- 10 mg/dl]. The Mean plasma G level in patients with TS=11-16, TS=6-10, and TS=1-5 was 130.74, 273.78, and 340 mg/dl, respectively. In the emergency stage of trauma, hyperglycemia is common. In addition, an increase in plasma G level has a direct correlation with severity of trauma and head injury

[Evaluation of different Sellick's maneuvers on laryngoscopic view in cesarean section]

Cricoid pressure [Sellick's maneuver] may alter the laryngoscopic view during tracheal intubation in parturients. This study was performed to compare the different techniques of Sellick's maneuver on laryngoscopic view in cesarean section. This was a clinical-trial performed on 142 parturients, aged 18-45 years of ASA I, and II undergoing elective cesarean section. Patients were randomly divided into 4 groups based on type of CP.1] In this group the cricoid pressure was performed using the index finger over the cricoid cartilage while the thumb and middle finger either side, in group 2] with the index and middle fingers over the cricoid cartilage while the palm of hand over sternum, in group3] with one hand behind the neck while the index finger over the cricoid cartilage and the thumb and middle fingers either side, and in group4] similar to the technique used for group C as well as using a pillow behind the head. Laryngoscopic view was determined following induction, laryngoscopy and CP. Data was analysed with spirmann, ANOVA, krusskal wallis, and X2 tests. A better laryngoscopic view was found in group 1 followed by 3, 4, and 2, respectively. There was significant differences between 4 groups based on laryngoscopic view changes [p=0.02]. No intubation failure in patients was observed during Sellicks's maneuver. The view at laryngoscopy during cricoid pressure was better than the view without cricoid pressure. The Sellick's maneuver in which downward pressure was applied with the left index finger over the cricoid cartilage and the thumb and middle fingers either side could produce the best laryngoscopic view in parturients undergoing cesarean section

[Correlation of body mass index and chronic pain in hospital personnel]

The last two decades have witnessed a remarkable increase in the number of people suffering a variety of painful syndromes. The goal of this study was to determine the correlation between body mass index and chronic pain in hospital workers during 2006. In this prospective descriptive study 210 cases were enrolled during 2006 at Beheshti and Ayatollah Kashani medical centeres. Variables such as demographic information, BMI, clinical presentations of chronic pain, and VAS were included. The data were analyzed using regression and correlation coefficient statistical tests. All cases were female. Most cases aged between30-39 years. The most common types of chronic pain were low back pain, knee pain, headache, and a combination of these discomforts. Nearly 65% of cases had severe pain. BMI range was at 19-24. There was no significant difference between BMI and VAS for chronic pain. Many workers suffer chronic pains leading to economical damages. Decrease in chronic pain could be achieved by considering the association between an individual's bodily strength and the person's physical activities and also vocational psychology hygiene

[Investigating the necessary volume of intravenous fluids in tumescent liposuction]

There is no general agreement on appropriate fluid resuscitation in patients undergoing liposuction. To determine the volume of intravenous fluid replacements in tumescent liposuction. This was a clinical trial in which 50 healthy patients undergoing liposuction by tumescent technique at Imam Musa Kazem Hospital. in Isfahan [Iran] were investigated during the period between 2001and 2006. The guidelines used for fluid resuscitation were the "4, 2, 1 rule" for group 1 with volume aspiration ? 4 liters, and "4, 2, 1 rule" plus 0.25 ml iv crystalloid per cc of aspirate larger than 4 liters for group 2 with volume aspiration > 4 liters. All patients were fully monitored for arterial blood pressure, pulse rates, respiratory rates, and Sa O2. Later, the data were statistically analyzed by SPSS using t-student and 2 tests. Mean absolute value of pulse rates 6 hours postoperatively were significantly lower than those obtained preoperatively. The mean absolute value of Sa O2 during operation was significantly higher than that of preoperation period. The mean variations of respiratory rates in patients who underwent volume aspiration ? 4 liters during and after operation were significantly higher than those with aspiratory volume > 4 liters. Tumescent liposuction surgery using large volumes of subcutaneous infusion could be regarded as a safe and effective technique if the fluid replacement, bleeding, perioperative complications, and postoperative infection are properly controlled

[Frequency of cardiac dysrythmia, blood pressure changes and level of arterial oxygen saturation during endotracheal suctioning in intensive care unit patients]

Introduction: Tracheobronchial suctioning has some complications for the patient. One of these complications is cardiac dysrythmia. Some articles mention ventricular extra systole to be common after suctioning but some other articles indicate bradycardia or premature arterial contraction [PAC] as the most common dysrythmia during endotracheol suctioning

Objective: In attention to the danger of cardiac dysrythmia during suctioning and also different existing opinions among researchers, the present study is conducted to determine the frequency of cardiac dysrythmia during tracheobranchial suctioning

Materials and Methods: Four hundred patients aging 18-65 under mechanical ventilation from intensive care units of Ayetoloh Kashani Center were selected. EKG, systolic and diastolic arterial pressure [SAP, DAP], heart rate [HR] and arterial hemoglobin saturation were recorded before the endotracheal suctioning. Then standard endotracheal suctioning was done and these parameters were determined during the suctioning. At the end of suctioning another EKG was taken and shown to the cardiologist. Data were analyzed using descriptive statistics, ratios and also analysis variance

Results: Mean age of the patients and M/F ratio were 33 +/- 14 yrs. and 17.2 respectively. The most common abnormal rhythm during the suctioning was sinus tachycardia [33%]. No other arrhythmias were seen in this study. The greater increase in HR occurred 2 minutes after endotracheal suctioning [114 +/- 20 vs. 102 +/- 16 pre suctioning][P<0.05]. Patients' systolic blood pressure significantly rose after suctioning [P<0.05]. There was insignificant difference in diastolic BP and saturated arterial hemoglobin

Conclusion: These findings suggested that endotracheal suctioning can induce sinus tachycardia but other dysrythmias, which may be dangerous in the patients under mechanical ventilation, did not occur in this study. Perhaps suctioning tracheal and bronchial secretions under correct medical conditions causes no dangerous arrythmias

[Evaluation of lidocaine and bupivacaine in post operation pain after abdominal hysterectomy]

Post operation pain is seen in 30-70 percent of patients. Using local anesthetic is a safe, easy and cheap method for post opration pain management. In this study, the effects of lidocaine and bupivacaine lavage on post operation pain are assessed. In this double blind randomized control clinical trial, 90 healty women between 15-60 years old randomly allocated in 3 groups, lidocaine, bupivacaine and normal salin. After abdominal hysterectomy the medicine or placebo [in uniform package] is Administered in peritoneal cavity by surgeon and, 0, 2,6,12,24 and 48 hours after the surgery, the rate of pain was checked. Consumption of morphin and frequency of vomiting were measured and compared between groups using SPSS 12 software. Post operational pain relief was significantly lower in lidocaine group compared with bupivacaine and normal saline, however, morphin consumption and frequency of vomiting were the same in three groups. Based on the results, it can be concluded that intraperitoneal lidocaine provides significant pain relief for 12 hours after abdominal hysterectomy

Frequency distribution of opiate poisoning according to individual characteristics and clinical manifestations

Opiates include natural alkaloids and synthetic derivates. Their pharmacologic effects are based on bounding opiate receptors. Peak toxic and therapeutic effect of opiate is 90 minutes after oral administration. Acute presentations of opiate poisoning are CNS, respiratory and Gl involvements. In long term, opiate can change numbers and sensitivity of their receptors, and result in tolerance or withdrawal syndrome. In opiate over dosage, morbidity and mortality decrease with careful therapeutic and supportive managements. Study of frequency distribution of opiate poisoning according to individual characteristics and clinical manifestations are the main objectives of recent investigation. in this retrospective descriptive study, 2520 patients were enrolled in 2001-2002. Information including demographic and clinical characteristics of the subjects was collected. 263 cases of 2520 [10.4%] were poisoned with opiates. The most frequent age group was 21-30 years old [38.3%] and the most common hospital stay was 1-7 days [55.8%]. The males were more poisoned than female [71.4%] and respiratory support was used for 29 patients [18%]. Poisoning route was often [68.8%] by ingestion [181 cases]. The most common clinical presentation was CNS involvement [74.1%]. The most common type of used narcotic substances was opium [60.4%]. Mortality rate was 4.5% [12 cases]. Opiate poisoning can result in morbidity and mortality. Complications were more among those who referred to hospital with delay or used high dose or potent agents. The main cause of mortality in opiate overdose was hypoxia with respiratory depression

Oral clonidine premedication decreases intraoperative bleeding in patients undergoing endoscopic sinus surgery

The antihypertensive drug, clonidine, is a centrally acting alpha 2 agonist, useful as a premedication because of its sedative and analgesic properties. We examined the effect of clonidine given as an oral premedication in producing a bloodless surgical field in patients undergoing endoscopic sinus surgery. We also evaluated the relation between bleeding volume and consumption of fentanyl and hydralazine to control hypotension. This prospective double - blinded clinical trial was performed on 113 patients [ASA I, ASA II]. Fifty-two patients received oral clonidine [5 micro g/kg] while the other 61 patients received placebo. During general anesthesia, the hemodynamic endpoint of the anesthetic management was maintenance of hypotension [MAP] at 70 mmHg for producing a bloodless surgical field. The direct control of MAP was attained with inspired concentration increments of halothane up to maximum of 1.5 vol% as needed. When it was unsuccessful, an intravenous fentanyl bolus of 2 micro g/kg was also added. When both drugs failed, hydralazine, was given intravenously as a bolus and intermittently, 0.1mg/kg up to a maximum dose of 40 mg. Intraoperative bleeding was assessed on a six - point scale from 0 [= no bleeding] to 5 [= severe bleeding]. Data were compared with chisquare test, fisher's exact test and Student t-test. There was less bleeding volume in the clonidine group [mean +/- SD] than in the placebo group [144 +/- 75 Vs 225 +/- 72 ml, P<0.05]. Frequency of bleeding severity scores 3 and 4 [troublesome with repeated suction] were lower in the clonidine group than in the placebo group [12% Vs 35%, P< 0.05]. Fentanyl requirement was significantly lower [112 +/- 18 Vs 142 +/- 21 micro g, P < 0.05] in the clonidine group. Hydralazine requirement was significantly lower [0.45 +/- 1.68 Vs 2.67 +/- 4.33 mg, P<0.05] as well. Premedication with oral clonidine reduces bleeding in endoscopic sinus surgery and also decreases fentanyl, and hydralazine consumption for controlling hypotension

effect of different Sellick's maneuver on laryngoscopic view and intubation time

Sellick's maneuver [cricoid pressure] may make laryngoscopic view and tracheal intubation more difficult. This study compared the different techniques of cricoid pressure [CP] regarding to the laryngoscopic view and time to intubation. In142 anesthetized patients, 4 types of CP was randomly applied; A] one-handed CP using thumb, index and middle fingers, B] one-handed CP using index and middle fingers, and the heel on the sternum, C] technique A with another hand below the neck, D] technique C with a pillow below the neck. There was significant difference in the laryngoscopic view changes. The view was better in group A, C, D and B, respectively. Mean intubation time did not show significant difference. One-handed CP using thumb, index and middle fingers can provide the best views at laryngoscopy without significant effect on time to intubation