The effect of positive end-expiratory pressure during anesthesia on arterial oxygen saturation after surgery in patient undergoing cesarean section

One of the major complications of general anesthesia in the recovery room is arterial oxygen desaturation and hypoxemia. Positive end-expiratory pressure (PEEP) can improve arterial oxygen saturation by increasing FRC. This study aims to evaluate the effects of applying PEEP on arterial oxygen saturation and hemodynamic parameters in the patient undergoing cesarean section in VALIASR hospital. In this double blind clinical trial we randomly allocated 120 patients of class1 and 2 ASA scheduled to undergoing cesarean section into 3 group (in 40).Different levels of PEEP (0, 5 and 10 CmH2o) were applied to each group while zero PEEP was established as control. All other variables (anesthesia and surgery techniques) were the same for all patients SPO2, noninvasive mean arterial pressure and heart rate were measured before, during and after surgery (Recovery room). The comparison of noninvasive arterial blood pressure and heart rate during and after surgery did not show significant differences but mean o2 saturation in group B (5 cmH2o PEEP) and C (10 cm H2o PEEP) in PACU was higher than control group (98.30±0.93 and 98.50±0.90 as opposed to97.12±1.15 respectively) P0<001. In light of results applying PEEP is effective in preventing desaturation after surgery and improving respiratory indexes without the significant hemodynamic changes, the result of using five cmH2o PEEP is more efficient and satisfying

Assessment of Pain Management in Pediatric Emergency Department in Mashhad -Iran

Introduction: Pain may be described as a sensation of hurt or strong discomfort and is the body's way of sending message to the brain that an injury has occurred. Pain medicines block these messages or reduce their effect on the brain. Accurate administration of analgesia have a long –lasting effect on children whole experience of medical care and affects parents' and children's future reaction to pediatrics emergency departments. The purpose of this study was to evaluate pain management on children in our emergency department. Materials and Methods: In this study we evaluated the relief of pain and anxiety on 100 children who referred to our pediatric Emergency Department (ED) in Imam Reza Hospital- Mashhad .The patients were assessed based on the American Academy of Pediatrics (AAP) recommendations about pain.  Results: Patients were gone under IV Line 97%, Intubation 5% and Lumbar Puncture 28%. Training had been provided to 70% participants in the Emergency Department. Nonpharmacologic stress reduction was used in 35% of cases. Family presence was allowed only in 5%. Prehospital pain controlling was began on 20% of patients and continued in ED on 40%. At the time of discharge 40% prescribed analgesics. Sedation and pain prophylaxis was provided for 10% of patients undergoing painful procedures in ED.  Conclusion: According to results, pain management in our Pediatric Emergency Department was inadequate. Physicians and prehospital EMS providers should be justified about the importance of pain relieving and trained how to use all available analgesic and sedative options

Study of the effect of added bronchoscopic suction to routine treatment of ventilator associated pneumonia patients in surgical ICU

Objective: Comparing BAL and antibiotic therapy with antibiotic therapy itself for treating VAP patients in ICU. Methods: In this randomized clinical trial. The first group was treated using antibiotics and closed-suction was performed daily, using 50 cc of sterile normal saline. The second group was treated with antibiotics and daily closed-suction with 50 cc of sterile normal saline, plus bronchoscopic suction every other day. Patients of both groups were followed and investigated one, 3, 7, and 10 days after initial diagnosis. Results: Mean blood leukocyte count and body temperature was measured in groups one (no bronchoscopy) and two (with bronchoscopy) in first, 3rd, 7th, and 10th days which was higher in the second group. Mean treatment status was also measured using APACHE II index. There was also a statistically significant difference in 3rd day (p-value < 0.05). There was also no difference in final culture result or mortality rate between two groups. Conclusion: According to the results of this study like lower body temperature, higher leukocyte count reduction, and lower APACHE II scores in the second group, treated with bronchoscopic suction, adding bronchoscopy seems to be more useful than normal method. Keywords: Bronchoscopy, Pneumonia, VAP, Continuous..