Actual Preoperative Fasting Time; A Report From Guilan Academic Hospitals: A Cross-sectional Study

Objectives: Traditional guidelines for preoperative fasting (POF) time lead to several complications in surgery patients. However, not enough attention has been paid to the issue. This aimed of this study was to investigate the management of fasting times in Guilan academic hospitals. Materials and Methods: In this descriptive cross-sectional study, individuals from five academic referral centers enrolled the survey and questionnaires including demographic characteristics, fasting hours for liquids and solids, POF recommenders, and patient’s knowledge regarding the definition of clear liquids were completed. Results: A total of 390 individuals candidate for elective surgeries enrolled in the study, the mean age of our cases were 46.61 years. The average POF time for solids and liquids was 11.43 and 9.70 hours, respectively. 95.38% of the participants did not know a correct definition of clear liquids, which was not related to their level of education (P=0.314). A positive association was observed between age and POF times for liquids and American Society of Anesthesiologists Classification for both solids (P=0.010) and liquids (P=0.0001). Conclusions: It was found that the real POF time in our hospitals was significantly longer than the modern guidelines, and needs to be corrected

Administration of NTG before embryo transfer does not increase pregnancy rate

Background: Recent studies of uterine contractility in IVF–embryotransfer led us to consider an alternative, and possibly complementary,explanation for the high implantation rates of blastocysts.It has been demonstrated that myometrial contractile activityinfluences embryo implantation, possibly through mechanicaldisplacement of embryos. Objective: The aim of this study was to examine the effect of nitroglycerine (NTG)treatment for priming the uterus on the pregnancy outcome of ICSI-ET programs. Materials and Methods: This study was a prospective, randomized, double-blinded placebo-controlled clinical trial. One hundred consecutive cycles of ICSI-ET on infertile couples were randomly divided into treatment and control groups. The treatment group (50 cycles) received an oral dose of 0.4 mg of NTG, and the control group (50 cycles) received a placebo, 15 minutes before fresh ET. An informed consent from was obtained form each patients. The main outcomes were implantation rate (IR) and pregnancy rate (PR). Results: The mean age of females in the control group and in the treatment group were 30.1±5.1 and 31±5.5 years respectively. Data showed that the mean duration of infertility was not significantly different between control and treatment groups (6.6±5.8 versus 7.8±5.1 years, respectively). The mean number of oocyte retrieval (metaphase II), 2pn, embryo cleaved, embryo transferred and PR weren't different between two Groups (p>0.05). Overall PR was 36%, it was 38% in treatment group and 34% in control group but there wasn’t statistically significant difference between two groups. (p>0.05) Conclusion: NTG didn't increase PR compared to placebo group. These results suggest that NTG treatment before ET isn't effective in the priming of a uterus

Oral Ketamine or Nasal Midazolam for Sedation in Pediatric Upper Gastrointestinal Endoscopy

Background: There is no agreement on the route of administration and the drug of choice for providing adequate sedation for pediatric invasive procedures. Objectives: We compared the utility, safety, and sedation effects of intranasal midazolam and oral ketamine. Materials & Methods: This double-blind clinical trial was performed on 100 children aged 2 to 14 years who were candidates for upper gastrointestinal (GI) endoscopy. Patients were randomly assigned to two groups: ketamine (4 mg/kg orally) and midazolam (0.1 mg/ kg intranasal). Sedation score, fear levels, children’s behavior at the time of separation from parents, and vital signs were recorded. Results: Higher systolic blood pressure was seen in children who received ketamine (P=0.012) and lower arterial oxygen saturation in the midazolam group (P=0.023). Also, the level of sedation showed no significant difference between the groups. Conclusion: Based on the results, administering oral ketamine or intranasal midazolam before endoscopy induced a similar sedation score in children. Also, both methods could be safe and non-invasive modalities for sedation

Knowledge and Attitude of the Faculty Members and Residents of Guilan University Towards Medical Errors, Barriers, and Predisposing Factors : Medical Error, Barriers and Predisposing Factors

Background: Patient safety is among the main goals in a health system. Medical errors are considered a significant threat to patient safety. An effective strategy to reduce this risk is reporting these errors even when the patient is not affected. This study investigated the main barriers to reporting medical errors and related factors.Methods: This cross-sectional descriptive study was conducted in academic hospitals afflicted with Guilan University of Medical Sciences (GUMS) in 2020. University faculty members and residents enrolled in the survey, and a questionnaire was filled out via a face-to-face interview by the responsible resident of anesthesiology.Results: Overall, 366 individuals, 156 faculty members, and 210 residents completed the questionnaires. Overall, 271 (74.2%), 134 (85.9%) faculty members, and 137 (65.6%) residents, the main barrier to report medical errors was concerning legal consequences. Furthermore, the other important factors were concerning losing job credit (63.4%) and losing the patient’s trust (61.2%). Moreover, the main predisposing factors of medical errors were high workload and a large number of patients (83.3%), long work shifts, and physicians fatigue (80.8%). High job stress and the lack of feeling of support from higher authorities (70.5%), and the lack of adequate equipment and appropriate medical facilities (56%) were the most related factors based on their perspective.Conclusion: According to the obtained findings, the main barrier to reporting medical errors was legal consequences. Moreover, the main predisposing factors were high workload, many patients, long working shifts, and physicians’ fatigue. Attempts should be made to plan programs to improve the current conditions