Short Communications: : Causes and Consequences of Complaints Against Anesthesiologists: A 5-year Retrospective Study

Background: Nowadays, complaints against the medical staff and the demand for physicians’ malpractice compensation are increasing. Anesthesiologists are also faced with medical litigation. Because of the importance of this issue and lack of such a research in Guilan Province, this study was conducted to determine the causes and consequences of complaints against anesthesiologists. This study aimed to reveal the anesthesia malpractice claims and underlying factors of its medico-legal litigations.Methods: This study surveyed all complaints against anesthesiologists from the Medical and Forensic Medicine Organization of Rasht from 2011 to 2015. Results: In this study period, 40 complaints against anesthesiologists were registered. The patients who complained were mostly male (52.5%), married (72.5%), and aged >50 years (62.5%). Of these, 6 medical malpractice were occurred (15%). Death of patients (55%) was the most common cause of complaints and negligence is the highest rate of failure by anesthesiologists (90%). Patients in general surgery wards under general anesthesia in governmental educational hospitals were affected the most; 45% in recovery and 27.5% in ICU sectors. In addition, 15% of all referred anesthesia-related malpractice claims positive legal action.Conclusion: Based on the results, a great concern over the performance of assistants in educational care centers, especially in general surgery ward is recommended. It is also necessary to monitor patient’s status carefully in the recovery room and use experienced personnel in there as well as intensive care units

The Effectiveness of Intravenous lidocaine in Burn Pain Relief: A Randomized Double-Blind Controlled Trial

Objectives: Poor pain control in burn patients as a great public health problem disrupts the healing and rehabilitation process and results in several adverse outcomes. The aim of this study was to investigate the efficacy and safety of intravenous lidocaine in reducing the pain of burn injuries. Materials and Methods: From August 2014 to March 2015, 66 eligible burn patients participated in the study and were randomly divided into two groups of lidocaine (L) and placebo (P). In group L, lidocaine 2% was injected at a bolus dose of 1.5 mg/kg followed by infusion at the dosage of 1.5 mg/kg/h, and in group P, saline was administrated. Pain severity was measured during 24 hours at baseline and 1, 2, 4, 8, 12, 16, 20, 24 hours after intervention based on Numerical Rating Scale (NRS-11). Morphine consumption, Ramsay score, and side effects were also documented. Results: Finally the data from 60 patients were analyzed. Comparing baseline with 24 hours after intervention, NRS-11 scores decreased from 7.12±1.42 to 3.33±0.76 (P<0.001) in group P and from 6.45±1.02 to 2.50±0.72 (P<0.001) in group L. Moreover, the mean of NRS scores during 24 hours in the lidocaine group was significantly lower compared to the placebo group, 3.93±0.72 vs 4.73 ±1.14, (P=0.03). The mean amounts of morphine consumption in group L were significantly lower compared to group P, 14.41 ± 4.86 vs 21.07±6.86, (P=0.001). The mean of Ramsay score in group L was significantly lower compared to group P, 1.38±0.59 vs 1.45±0.6, (P=0.014). Conclusions: This study revealed that intravenous lidocaine was an effective and safe drug for pain reduction in burn patients

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

Atracurium as an Alternative to Succinylcholine in Electroconvulsive Therapy: A Randomized Clinical Trial

Background: Electroconvulsive Therapy (ECT) is a successful treatment option for various psychiatric disorders. It is performed under general anesthesia where succinylcholine is the preferred muscle relaxant in this process. However its several contraindications and potential adverse effects, and the fact that it is not always available should be considered. Therefore, finding an effective and safe alternative is crucial. Objectives: This study aims to assess the safety and efficacy of atracurium in ECT. Materials & Methods: This single-blind clinical trial was conducted at Shafa hospital affiliated to Guilan University of Medical Sciences from November 2020 to April 2021. Participants were 67 eligible patients with ECT, randomly assigned into two groups receiving succinylcholine (0.5 mg/ kg), and atracurium (0.2 mg/kg). Seizure duration, hemodynamic parameters, the time to return to spontaneous breathing, and recovery time were assessed and compared between the two groups. Results: Seizure duration was longer in the succinylcholine group (P=0.071), while the time to return to spontaneous breathing (P=0.0001) and the recovery time (P=0.0001) were significantly longer in  the atracurium group. The trend of changes in the Mean Arterial Pressure (MAP) and Heart Rate (HR) were significant over time; however, the difference between the two groups was significant only in HR one minute after the seizure induction (P=0.001). None of patients was reported serious adverse effects. Conclusion: When succinylcholine can't be used, atracurium can be a safe alternative in the ECT process

Acupuncture and botulinum toxin A injection in the treatment of chronic migraine: A randomized controlled study

Background: Migraine is a common type of headache. Sometimes adequate pain relief is not achieved by conventional treatments. Acupuncture and botulinum toxin-A injection are known as non-pharmacological interventions for this purpose. The aim of this research was to compare the effect of acupuncture with botulinum toxin-A injection and pharmacological treatment in controlling chronic migraine. Methods: This clinical trial was conducted on patients with chronic migraine in the North of Iran during 2014-2015. Eligible patients were randomly allocated to groups receiving acupuncture (A) or botulinum toxin A (B) and controls (C) by designed quadripartite blocks. All patients were evaluated at baseline, one, two and three months after treatment using visual analogue scale (VAS) score and other parameters. The analysis of data was performed in SPSS software Version 19. Results: One hundred fifty patients (48 males and 102 females) completed this study. During the 3- month study, the pain severity significantly diminished in three groups (P=0.0001), with greater reduction in group A (P=0.0001). The number of days per month with migraine, absence from work and the need for medication significantly decreased in three groups at 3 times of evaluation (p<0.05) with fewer side effects in group A (P=0.021). Conclusion: Acupuncture, botulinum toxin-A injection and pharmacological treatment have beneficial effects on chronic migraine; however, acupuncture showed more effectiveness and fewer complication

Knowledge, Attitude, and Performance of Pregnant Women Regarding General Anesthesia Neurotoxicity in Children under Three: A Report from an Academic Hospital

BackgroundRecently, concerns about general anesthesia (GA)-related neurotoxicity has been growing in societies. Parents' information obviously plays an important role to make right decision for elective surgeries on children aged under three years old.ObjectivesThe aim of this survey was to evaluate the knowledge, attitude, and performance of pregnant women about the GA-related neurotoxicity in children aged under three years old.MethodsThis descriptive study was conducted at Alzahra Teaching Hospital in Guilan, Iran, during 2020. The eligible pregnant women admitted to this center were interviewed, and a questionnaire containing 10 items was filled out by the responsible resident of anesthesiology.ResultsIn this research, a total of 361 pregnant women were enrolled and underwent a face-to-face interview. The mean age of the participants was 31.4 ± 7 years, 64.5% were living in urban areas, 82.5% were housewives, and 65.7% were multipara. Moreover, 83.7% of participants believed that receiving information in this regard was crucial, and 81.7% preferred physicians as the source of information. Only 8% of mothers had received information regarding the issue. A significant correlation was observed between the habitat, employment, the level of education, knowledge, and attitude status, and the source of receiving information.ConclusionsAccording to our results, the knowledge, attitude, and performance of pregnant women were not optimal and needed to be improved through practical strategies

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