Comparison of intravenous ranitidine with pantoprazole in decreasing gastric fluid acidity in emergency cesarean section

Peri-operative aspiration of gastric contents is a problem that causes certain respiratory problems including ARDS. Prophylaxis against aspiration of gastric contents is performed routinely in elective surgeries, but there is rare evidence on the efficacy of this method in emergency cesarean section. This is a randomized, controlled, double-blinded clinical trial. 60 parturients undergoing emergency cesarean section were randomly assigned into three groups of 20 each. They were allocated into two study and one placebo groups. The study group one and two received intravenous ranitidine [IV] 50 mg or IV pantoprazole 40 mg, half an hour before induction of GA, respectively. The placebo group was administered just 5 ml of isotonic saline half an hour before GA induction. After intubation and confirmation of endotracheal tube insertion, the gastric contents were aspirated through a nasogastric tube for evaluation of acidity and volume. A statistical difference between group one and two with the control group was observed in the acidity of gastric contents, but there was no difference in volume. Also, the PH level of gastric contents in patients receiving pantoprazole was significantly higher than the isotonic saline [p<0.001] and ranitidine groups. The difference in average level of acidity of gastric contents in patients receiving pantoprazole and ranitidine showed a marginal significance [p

Educational needs of nurses in intensive care unit for poisoned patients

Poisoned patients are at risk of impaired ventilation in many situations. The purpose of this descriptive study was to investigate the impact of educational workshops on nurses' knowledge, confidence, and attitude in taking care of poisoned patients. This descriptive study was performed on 60 nursing staff in the intensive care unit [ICU] for poisoned patients in Imam Reza [p] hospital, Mashhad, Iran. Data was gathered by a researcher-designed questionnaire. Studied scales included perceived importance and novelty of educational meeting, matching with professional and educational needs, illustration of practical and knowledge weaknesses and strength and finally satisfaction in holding regular workshops annually. Two, half day workshops were held and various items were taught with various methods. The knowledge of participants was assessed by pretests and post-tests consisting of 12 items related to workshop topics. The impact of these educational meetings was evaluated and the results were analyzed by the SPSS software. According to the results, workshops improved awareness of nurses about their weakness and strength points, professional knowledge and their interest and attention; likewise all participants had the same opinion about a strong need to hold similar workshops more than once and preferably 2 to 3 times annually. It seems that short educational courses in small groups for reviewing the old data and recent findings in the context of critical care are useful in order to promote the knowledge and skills of ICU staff in taking care of poisoned patients.

Percutaneous retrieval of a dislodged guide wire by dormia basket in a 98-year-old patient, still a safe and feasible approach

Since the first report of percutaneous retrieval of intravascular foreign body in 1964, it has been accepted as a favorite approach for intravascular foreign body removal. Various instruments such as snares, biopsy forceps, dormia basket or tip deflecting wires are available for this approach. Herein, we report percutaneous retrieval of a dislodged guide-wire by dormia basket. The Patient was a 98-year-old female who was admitted in the Intensive care unit due to confusional state. The physian incharge left the guide-wire in her subclavian vein during central venous catheter insertion. He realized his fault immediately, so he started anti-coagulation therapy and requested surgical consult. Because of the patient's high risk of surgery, the surgeon referred the patient to cardiologist for non-invasive guide wire removal. The guide wire was apprpached through femoral vein by a dormia basket [4/6 F] and it was removed without any difficulties or complications. Utilization of baskets for intravascular foreign body removal is frequently reported and has been successful with low complication rates; In addition, the low cost of the device makes it less of a burden to the patient and the hospital

[Effect of magnesium sulfate on cardiac arrhythmias after open heart surgery]

Postoperative cardiac arrhythmias are among the most common complications of cardiac surgery. The purpose of this study was to assess the effect of infusion of magnesium-sulfate on the incidence of cardiac arrhythmias especially atrial fibrillation [AF] and premature ventricular contraction [PVC] in patients undergoing on-pump coronary artery bypass grafting [CABG]. In this clinical trial 120 patients were randomly divided into two groups. In experimental group sixty patients received intravenous magnesium-sulfate 2gr at the night before operation and 2gr during operation and 30mg/kg on the first, second, third, and fourth days after surgery. In control group sixty patients underwent surgery as the routine treatment. Incidence of atrial fibrillation and premature ventricular contraction were evaluated during and after surgery. For analysis of qualitative variables, X[2] and Exact Fischer tests were used. Preoperative patient characteristics and operative variables were similar in both groups [P>0.05]. No postoperative AF was detected in the patients of magnesium group, while 4 [8.3%] patients in control group developed AF post-operatively [P=0.03]. Post-operative PVC occurred in 12 [20.7%] patients of magnesium group and in 21 [42.9%] patients of control group [P=0.02]. Infusion of magnesium sulfate during operation seems to be effective in the prevention of new episodes of AF and PVC after coronary artery bypass grafting [CABG]

[Evaluation of general anesthesia in pediatric dental procedures]

The use of general anesthesia for extensive dental procedures in children is sometimes necessary to provide safe, efficient, and effective care. Hospital dentistry and using general anesthesia is limited in our country. The aim of this study was evaluating the extensive pediatric dental procedures which have been done under general anesthesia during a two-year period. This descriptive cross-sectional study was done on 72 pediatric patients who had been transferred into the operating room for dental procedures. General anesthesia was induced with sevoflurane in presence of parents. Then anesthesia was maintained with propofol or remifentanyl and nitrous oxide. Vital signs and any predefined intra and postoperative side effects were recorded. Statistical analysis was performed in SPSS software using mean values and standard deviation. The mean age of the patients was 7.2 +/- 4.10 years and mean anesthesia time was 2.1 +/- 1.48 hours. Thirty one patients [43.1%] had no coexisting disease. 26.4% had cerebral palsy and 15.2% had mental retardation. 15.3% of patients had unknown syndromes. Dental procedures included 215 palpotomies, 57 palpectomies, 293 amalgam fillings, 123 glass-ionomer restorations, 15 scalings, 138 extractions and 101 crown cases. Tachycardia was reported in 9 patients, bradycardia in 7, and hypertension in 6 and hypotension in 1 case during anesthesia. Hemorrhage and swelling were the most common complications during interventions that were seen in 7% and 2.1% respectively. 592 teeth were treated finally. Vomitting, pain and agitation were more common complications after recovery that was reported in 28, 17 and 7 cases respectively. Illusion and restlessness occurred in one patient due to central anticholinorgic syndrome which resolves spontaneously 96 hours after the surgery. Although it is impossible to have a control group under local anesthesia due to long operation time, in our study, extensive dental procedures under general anesthesia were an acceptable method with few preventable complications in special cases such as poor cooperation even in presence of coexisting diseases. Certainly, quality of care will be increased with providing hospital dentistry programs. More studies with more cases are needed

Comparison of the effects of inhalational salbutamol, inhalational beclomethasone and intravenous lidocaine in prevention of fentanyl-induced coughing before induction of anesthesia

Fentanyl, a synthetic opioid is a popular choice amongst anesthesiologists in the operating room, Preinduction IV fentanyl bolus is associated with coughing in 28-45% of patients. Coughing due to fentanyl is not always benign and at times maybe explosive requiring immediate intervention. The goal of this study was to compare the role of inhalation of salbutamol beclomethasone and IV lidocaine in preventing fentanyl induced coughing. This clinical trial study was performed in Ghaem Hospital in 2006. 320 patients aged 20-60 years, undergoing elective orthopedics surgery were randomized into four groups of 80. Group I served as control, while groups II, III, IV received an inhalation of salbutamol, beclomethasone or IV lidocaine before induction of anesthesia. Following IV fentanyl [2 micro g/kg] the incidence of cough was recorded and graded as mild [1-2], moderate [3-4] and severe [>/= 5] depending on the number of coughs observed. Patients' characteristics and coughs, and the results of using different drugs were recorded in a questionnaire and analyzed by descriptive statistical methods. A p value of =/< 0.05 was considered significant. The incidence of cough was 40% in the control group, 6.25%, 1.25% and 11.25% in the salbutamol, beclomethasone and lidocaine groups, respectively. Occurrence of cough was significantly low in the treatment groups; however the difference among the groups was not significant. The use of inhalation salbutamol, beclomethasone or IV lidocaine prior to IV fentanyl administration minimizes fentanyl induced coughing, and in conditions like corneal rupture or increased intracranial pressure, which coughing is highly dangerous, they are beneficial

Cardiac rupture following acute myocardial infarction

Ventricular rupture following myocardial infarction [M.I] is a serious clinical problem with a high mortality. The aim of this study was to present a case with this disorder. A 73 year-old man with left ventricular rupture and cardiac tamponade following myocardial infarction was managed successfully by emergency surgery. The procedure was accomplished with the use of cardiopulmonary by pass. A large PTFE patch was sutured according to the Nunez technique. Patient survived during a mean follow-up of 12 months

[Effect of Digoxin, Hydrocortisone and Amiodarone [DHA] in prevention of atrial fibrillation following off-pump coronary artery bypass grafting]

Numerous studies have suggested that postoperative atrial fibrillation [AF] occurs in 30 to 50% of patients, leading to significant morbidity, including hypotension, heart failure, thromboembolic complications, prolonged hospital stay and increased hospital costs. The purpose of this study was to evaluate the safety and efficacy of preoperative administration of prophylactic IV single and loading doses of Amiodarone, Digoxin and Hydrocortisone [DHA] in the prevention of new onset postoperative AF in patients undergoing coronary artery bypass grafting [CABG] without cardiopulmonary bypass facility. In this prospective study, 100 patients were randomly divided into two groups: 50 patients [study group] received intravenous Amiodarone in a dose of 300 mg, Digoxin 0.5 mg and Hydrocortisone 200 mg, and 50 patients treated routinely in control group. Preoperative patient characteristics and operative variables were similar in two groups. Postoperative AF occurred in 4 patients [%8] in study group and in 12 patients [%24] in control group. Preoperative intravenous single and loading dose of Amiodarone, Digoxin and Hydrocortisone appears to be effective and safe in the prevention of new onset AF after off-pump CABG

[Tracheal intubation without muscle relaxants in patients under coronary artery bypass surgery]

Although the conventional technique in coronary artery bypass surgery [CABG] consists of using long-acting opioids and muscle relaxants, but in some situation usage of long acting drugs may be hazardous. Administration of remifentanil followed by propofol provides adequate conditions for tracheal intubation without muscle relaxants. This study was performed to evaluate intra thracheal intubation without muscle relaxants in CABG. This double - blind clinical experimental study was done in the cardiosurgery department of Imam Reza Hospital in the year 2004. Intubation conditions and hemodynamic and ST changes in premedicated patients, candidate for CABG surgery was compared. 90 patients with New York heart association class I-II were assigned to one of three groups [n=30]. After prehydration with ringer solution, sufentanil l micro/kg or remifentanil 2 or 4 micro /kg was injected followed by 1.5 mg/kg propofol. Ninety seconds after administration of the propofol, laryngoscopy and intubation were attempted. Intubation conditions were assessed using a four-point scoring system. ST changes, heart rate and mean arterial pressure measured invasively before induction to five minutes thereafter [6 time point]. Data was analyzed using descriptive statistics, chi 2 and T tests, and frequency distribution tables. Tracheal intubation was successful in all patients without any problems. Intubation conditions were also clinically acceptable in all groups. Mean arterial pressure, HR and ST changes were not different between the groups significantly. It is concluded that varying doses [2-4[micro/kg] of remifentanil administered before propofol provides acceptable tracheal intubation condition and hemodynamic changes comparing to conventional technique in patients with coronary artery disease