Sudden cardiac arrest in COVID-19 young patient: A Case Report

Following the outbreak of COVID-19 since December 2019 many reports have been published to conclude different presentations of this new infection. This report contains a summary of a young patient with a history of methadone intake, which experienced a cardiopulmonary arrest while he was preparing to take a lung Computerized Tomography (CT) scan in an outpatient setting. After a successful Cardio-Pulmonary Recovery in the CT scan room he was admitted in Intensive Care Unit. He had a prolonged QTc interval in Electrocardiograph and bilateral pulmonary involvement in Chest X-Ray

Impact of educational interventions on the prevention of emerging diseases: A systematic review

Background: Seasonal influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) couldcause considerable morbidity and mortality. The present study investigates the effectiveness of educationalinterventions to prevent these diseases.Materials and Methods: We searched PubMed/Medline, Embase, and Cochrane Controlled Register of Trials(CENTRAL) for relevant clinical studies up to March 25, 2022. The following terms were used: “influenza”,“flu”, “respiratory infection”, “prevent”, "severe acute respiratory syndrome", COVID-19 “intervention”,“education”, “school-based”, and “inform”.Results: Out of 1296 studies retrieved from databases, 13 types of clinical trials met the inclusion criteria andwere included in the study. E-learning and the educational module were the most common interventions forinfluenza and COVID-19, respectively. The measured outcomes were health promotion strategies andpreventive behaviors among participants. All except one article showed a significant association betweeneducational interventions and outcomes.Conclusion: The included studies in the current systematic review indicated the efficacy of health promotioneducational interventions in improving knowledge and preventive behaviors regarding COVID-19 andInfluenza

Full recovery after cardiopulmonary resuscitation in lateral position necessitated by hemorrhagic shock

 Introduction: Cardiac arrest during general anesthesia is often witnessed and anticipated with better prognosis. But it may have some difficulties as positions other than supine. Case Presentation: A 43-year-old woman underwent a left radical nephrectomy due to renal cancer while in a lateral position. Her operation was complicated by massive bleeding because of a laceration in the inferior vena cava. Due to rapid blood loss, pulseless electrical activity occurred. Chest compressions were administered with the patient in the lateral decubitus position. Following a blood transfusion, IV fluid administration, FFP, induced hypothermia, fresh whole blood and norepinephrine infusion, the patient was stabilized. She was transferred to ICU, and after 24 hours she was extubated. The next week she was discharged with no neurological damage. Conclusion: Initiating chest compressions as soon as possible even in positions other than supine could minimize hypoxic complications and enhance prognosis of cardiac arrest.

Evaluation of outcome in sticking upper limit and lower limit in BIS monitoring for radical cystectomy

Introduction: The electroencephalogram-derived bispectral index (BIS) is a promising new method to assess anesthetic adequacy.  The purpose of this study is to evaluation of outcome in sticking upper limit and lower limit in BIS monitoring for radical cystectomy surgery.Methods: 202 patients with elective radical cystectomy were selected randomly and divided into two groups of BIS (40-50) and BIS (50-60). The patients were blinded to the study group (BIS). Initially demographic and clinical information such as age, sex, weight, recovery time, patient extubation time, awareness during surgery, mortality rate and patient stay in hospital, BIS and patient cost were included in data collection form.Results: There were 197 males and 5 females and the average age of the patients were 67.12±8.1. There is significant relationship between recovery time, amount of anesthetic used,  ICU stay, hospital stay, hospital cost, and BIS monitoring range.(p value<0.001). Also there is significant relationship between extubation time and BIS monitoring range. (p value=0.001). The relationship between PONV with BIS monitoring range is significant. (p value<0.001). But there was no significant relationship between Analgesic drugs (p value=0.26) and awareness (p value=0.175) and mortality (p value=0.651) with BIS monitoring range.Conclusion: The conclusion is that by increasing the BIS value, the anesthetic dose, extubation and recovery time, hospital and ICU stay were significantly reduced as well as the cost

EFFECT OF BODY COMPOSITION ON CISATRACURIUM EFFICIENCY

Abstract: Measurement of body composition is proving increasingly important in clinical nutrition and research. In current study we investigated about the effect of body composition on cisatracurium efficiency. In this descriptive cross sectional study, 180 patients with elective non-cardiac surgery under general anesthesia with muscle relaxation and under ventilation with ventilator referred to Shahid Modarres Hospital were selected randomly from simple random sampling. Fat mass and muscle mass(BMI and TBW ) in patients, that measured by BODY COMPOSION ANALYZER set, was recorded and compared with duration of effect time of cisatracurium, extubation time, cisatracurium dose during oeration , recovery time, and onset time Correlation between quantitative variables was determined using Pearson correlation coefficient and Spearman rank tests for statistical analysis of data using SPSS 21 software. In this study p value<0.05 considered statistically significant. it was concluded that duration of effect time of cisatracurium, extubation time, recovery time, and onset time were decreased with increased muscle mass but the cisatracurium dose during operation was increased, in contrast duration of effect time of cisatracurium, extubation time, recovery time, and onset time were increased with increased fat mass but the cisatracurium dose during operation was decrease

Comparison of Tracheal Extubation Comfort between Two Endotracheal Tube Filling in Laparoscopic Cholecystectomy

Background: Post-intubation airway complications such as cough and sore throat are common complaints after anesthesia. After intubation, filling the endotracheal tube will close the tube space and stimulate the endotracheal tube. It is used to fill the cuff with air or liquids such as normal saline, lidocaine, etc. The purpose of this study was to compare the comfort of tracheal extubation between the two methods of filling the tracheal cuff with lidocaine 2% and filling with air in patients undergoing laparoscopic cholecystectomy.Methods and materials: In this single-blind clinical trial study, 70 patients were randomly divided into two groups of air and lidocaine. In the lidocaine group, the endotracheal tube cuff was filled with 2% lidocaine and in the air cuff group the cuff pressure reached 20 to 25 cm of water. Blood pressure and heart rate of patients before induction, after induction, 30 and 60 minutes after and before and after extubation, as well as complications of intubation including bucking, cough and sore throat during recovery, 6 hours and 12 hours later were compared. Data were analyzed using SPSS software version 16.Results: The results of this study showed that there were no significant differences in heart rate at different intervals of the study including pre-induction, post-induction, 30 and 60 min, before and after extubation. But the systolic and diastolic blood pressure after extubation were significantly lower in the lidocaine group than in the air group, although at other intervals there was a significant difference between the two parameters in the study groups. After extubation, sore throat complications were significantly lower at all study intervals.Conclusion: According to the results of the same study, it seems that filling the cuff with lidocaine over the air leads to more hemodynamic stability and less side effects after extubation.Keywords: Intubation, Lidocaine, Complication

The Effect of Stretching Exercises and Caffeine Tablets on Reducing Headache after Spinal Anesthesia; A Randomized Clinical Trial

Abstract Introduction: We performed this study to compare the effect of Caffeine and stretching exercise on Post Dural Puncture Headache (PDHP). Methods: In this Randomized Clinical Trial, 160 candidates for elective inguinal hernia surgery or varicocele surgery in Shahid Modares Hospital in Tehran, were assigned into the following groups using a computer-generated randomization table: caffeine group received Caffeine tablet (200 mg TDS); exercise group received stretching exercise; caffeine combine exercise group received Caffeine tablet (200 mg TDS ), and stretching exercise and control group received placebo tablets. After the end of the surgery, up to 48 h, the Visual analog scale (VAS) was recorded every 6hours by the same clinician. Results: The occurrence of PDPH was less in the caffeine and exercise combined group than in the control group. Also, the headache was more severe in the control group than in the caffeine group. Furthermore, the need for rescue analgesics was more in the control group than in the caffeine group. Conclusion: caffeine and exercise combined had better outcomes than placebo regarding PDHP. &nbsp

Effect of Acid-Base Balance on Cytokines Serum Levels and Short-Term Outcomes in Kidney Transplant Recipients; a Randomized Clinical Trial

Background: Control of blood acids and bases can help prevent many potentially life-threatening disorders in end stage renal disease (ESRD) patients. Aim of this study was to assess the effect of acid-base balance on cytokines serum levels and short-term outcomes in kidney transplant recipients.Materials and Methods: In this randomized clinical trial study, 40 patients with end-stage renal disease aged 18 to 70 who had undergone a kidney transplant from a living donor in Modarres hospital during 2016-2017 were included. The primary outcomes measured in this study were sera levels of cytokine such as IL-2, IL-10, IFN-γ and BUN and Cr serum after the treatment of acidosis in kidney transplant recipients.Results: Mean±SD of the patient’s age was 42±12.6 years. Results showed that there is a significant difference in means of IL-2, IL-10, and IFN-γ between the intervention and control groups over the time (for all p<0.05). We also found that correction of acidosis occurred with reduces of IFN-γ to -1.74 in the intervention group compared to the group receiving saline (P=0.011); and reduction for IL-2 was -1.37 (p=0.025). The concentration of anti-inflammatory cytokine of IL-10 was increased to 2.85 (P<0.001).Conclusion: The results clearly suggest that correction of acidosis in renal transplant patients during surgery helps improve the performance of allograft in the short run; however, more studies are recommended, taking into account the long-term and short-term effects of this intervention.Keywords: Cytokines, Kidney Transplantation, Acid-Base Balance, Randomized Controlled Tria

The Effect of Perioperative Dimethyl Sulfoxide Efficacy on Regional and Local Flaps Viability

Background: The purpose of this study was to analyze the effects and results of dimethyl sulfoxide (DMSO) usage on viability and perfusion of local and regional flaps in rabbits, via this study we are going to conclude whether DMSO could be effective after flap operations in human or not. Materials and Methods: Local and regional DMSO spray was used on rabbit’s dorsum flaps immediately after the operation and once per day up to 7 days post-op in 14 rabbits, divided equally to control group (saline solution spray) or experiment group (DMSO spray). The results were compared 3 and 7 days after operations. Results: There were improved results attributed to the DMSO effects regarding flap survival Conclusion: We concluded that topical application of DMSO reduces skin flap ischemia in rabbits and we highly advise the use of it after operations in which skin flaps are created

Preoperative Pulmonary Function test and Pulse Oximetry among Patients Recovered from COVID-19 Who Were Candidates for Elective Surgery

Background: This descriptive study aimed to assess preoperative pulmonary function test (PFT) results and pulse oximetry readings in patients recovered from COVID-19 who were candidates for elective surgery.Materials and Methods: This is a descriptive study. A total of 110 patients (men = 51) with a mean age of 52.6 years were enrolled in the study. The study protocol was presented to the ethics committee and received approval. Participants included patients with a positive SARS-CoV-2 PCR test history, with a recovery period of at least 6-8 weeks for symptomatic patients and four weeks for asymptomatic patients. Data collection involved a random selection, obtaining informed consent, and conducting a history and physical examination. Pulmonary function capacity and oxygen saturation were assessed, and frailty was evaluated using the Edmonton Frail Scale. Echocardiography and electrocardiography were performed on all patients.Results: The study participants mainly underwent trans-ureteral lithotripsy (TUL), laparoscopic cholecystectomy (LC), and percutaneous nephrolithotomy (PCNL). Symptomatic patients exhibited lower pulse oximetry readings than asymptomatic patients (91.18% vs. 96.13%, p-value = 0.005). Although the average ejection fraction was slightly lower in symptomatic patients (44.25%) compared to asymptomatic patients (48.18%), the difference was insignificant. Symptomatic patients also had higher rates of abnormalities in chest X-rays, electrocardiograms, pulmonary function tests, and fasting blood sugar levels, as well as a higher rate of ICU admission.Conclusion: Comprehensive preoperative evaluations, including pulmonary function and oxygenation assessment, are crucial for COVID-19 survivors undergoing elective surgery. Symptomatic patients showed lower pulse oximetry readings and higher respiratory and cardiovascular abnormalities rates. These findings emphasize the importance of optimizing perioperative management and minimizing complications by thoroughly assessing patients' preoperative health status