Advanced cardiac life support training by problem based method: effect on the trainees skills, knowledge and evaluation of trainers

Background: Cardiopulmonary-cerebral resuscitation (CPCR) training is essential for all hospital workers, especially junior residents who might become the manager of the resuscitation team. In our center, the traditional CPCR knowledge training curriculum for junior residents up to 5 years ago was lecture-based and had some faults. This study aimed to evaluate the effect of a problem-based method on residents’ CPCR knowledge and skills as well as their evaluation of their CPCR trainers. Methods: This study, conducted at Tehran University of Medical Sciences, included 290 first-year residents in 2009-2010-who were trained via a problem-based method (the problem-based group) - and 160 first-year residents in 2003-2004 - who were trained via a lecture-based method (the lecture-based group). Other educational techniques and facilities were similar. The participants self-evaluated their own CPCR knowledge and skills pre and post workshop and also assessed their trainers’ efficacy post workshop by completing special questionnaires. Results: The problem-based group, trained via the problem-based method, had higher self-assessment scores of CPCR knowledge and skills post workshop: the difference as regards the mean scores between the problem-based and lecture-based groups was 32.36 ± 19.23 vs. 22.33 ± 20.35 for knowledge (p value = 0.003) and 10.13 ± 7.17 vs. 8.19 ± 8.45 for skills (p value = 0.043). The residents’ evaluation of their trainers was similar between the two study groups (p value = 0.193), with the mean scores being 15.90 ± 2.59 and 15.46 ± 2.90 in the problem-based and lecture-based groups – respectively. Conclusion: The problem-based method increased our residents’ self-evaluation score of their own CPCR knowledge and skills

Effects of intrathecal opioids use in cesarean section on breastfeeding and newborns’ weight gaining

Objective: To assess the association between intrapartum intrathecal opioid use and breastfeeding and weight gain following cesarean section. Materials and methods: The prospective double-blinded study was conducted on term pregnant women, undergoing elective cesarean section under spinal anesthesia. They divided into two groups. In the first group, intrathecal Morphine was used to achieve analgesia during or after the operation. The remainder divided into two subgroups, those who did not receive any opioid or those received systemic opioids. Following labor breastfeeding accessed in a follow-up, two month latter. Results: There was no difference between the demographic variables of the mothers and newborns APGAR score and weight at the time of birth. Breastfeeding rate was similar in intrathecal group in compare with other patents (P value = 0.518). While, the infants’ weight at the end of second month was lower in spinal opioid group (P value = 0.036). Conclusion: The present study was the first to suggest that spinal (intrathecal) opioids do not have any impact on breastfeeding. However the relationship between spinal anesthesia on weight gaining needs more investigation

BOTH ORAL PASSIFLORA INCARNATA AND OXAZEPAM CAN REDUCE PRE-OPERATIVE ANXIETY IN AMBULATORY SURGERY PATIENTS: A DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY

Objectives: Pre-operative anxiety control without increased post-operative psychomotor dysfunction is an anesthesia concern especially in ambulatory surgery; so, the development of a strong anxiolytic with minimal psychomotor impairment for premedication is desirable. In this study, it was hypothesized that Passiflora incarnata decreases pre-operative anxiety (PAN) similar to oxazepam.Methods: In this double-blinded placebo controlled study, 128 patients were randomized into Passiflora group (n=68) who received oral P. incarnata and oxazepam group (n=60) who received oxazepam (10 mg) as premedication, 90 minutes before surgery. A numerical rating scale (NRS) was used for each patient to assess anxiety before, and 90 minutes following premedication. Psychomotor function was assessed with the trigger dot test (TDT) and the digit-symbol substitution test at arrival in the operating room, and 90 minutes after tracheal extubation.Results: The 90th minutes NRS anxiety scores were significantly lower in the Passiflora group compared with oxazepam group (p<0.001). There were no significant differences in psychological variables, in groups, in the postanesthesia care unit.Conclusion: In outpatient surgery, administration of oral P. incarnata as a premedication reduces PAN with similar psychomotor function impairment compared with pre-operative oral oxazepam

Comparison of Preventive Acetaminophen and Placebo in Pain Reduction After Cesarean Section; A Randomized Clinical Trial

Background: In subjects having a cesarean section, pain can increase hospital length of stay and postoperative complications. The preventive analgesia in the postoperative phase is known to be more effective than analgesic treatment in response to pain. Objectives: In this study, the analgesic efficacy of preventive intravenous acetaminophen was compared with placebo in relieving postoperative pain after cesarean sections under spinal anesthesia. Methods: In this double-blind randomized controlled study, 49 women undergoing elective cesarean section under spinal anesthesia were randomly allocated into two groups by block randomization in a referral hospital in Tehran in 2016. The intervention group received intravenous acetaminophen (Apotel®) (1 gram) and the placebo group received normal saline on arrival to the recovery room within 20 minutes. Then the total consumed doses of meperidine, visual analogue scale (VAS) score of pain, and the incidence of vomiting were determined and recorded for 24 hours postoperatively. Results: Pain scores (VAS) were lower in the acetaminophen group throughout the study, but the difference was only significant at forth to eighth hours after the surgery (P = 0.0001). The total consumed doses of meperidine to treat the pain was significantly lower in the acetaminophen group at the fourth to the eighth hours after the surgery (P = 0.0001). The incidence of vomiting was the same between the groups (P > 0.05). Conclusions: A single dose preventive intravenous acetaminophen has good efficacy in reduction of postoperative pain and reduces opioid use after cesarean sections under spinal anesthesia up to 8 hours after the administration

Dermal reaction and bigeminal premature ventricular contractions due to neostigmine: a case report

<p>Abstract</p> <p>Introduction</p> <p>Neostigmine is a frequently used acetylcholinesterase inhibitor administered to reverse muscular relaxation caused by nondepolarizing neuromuscular relaxants in patients recovering from general anesthesia. Severe allergic reactions and urticaria are rarely reported following the use of neostigmine bromide, and never with methylsulfate-containing drugs. In this case, bigeminal premature ventricular contractions added to urticaria provides a warning about the possibility of a life-threatening situation.</p> <p>Case presentation</p> <p>We report the case of a 23-year-old Persian woman who presented with bigeminal premature ventricular contractions along with urticarial lesions on her arm and trunk as soon as she was administered neostigmine methylsulfate after undergoing a laparoscopy for ectopic pregnancy.</p> <p>Conclusion</p> <p>This case report could be of value not only for anesthesiologists who routinely use neostigmine but also for others who administer the pharmaceutical preparation in other situations. The report presents a rare case of drug reaction following neostigmine use. As a result, one should consider any drug a probable cause of drug reaction. The preparation of resuscitative facilities, therefore, is necessary prior to the prescription of the medication.</p

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 &gt;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 Effect of Preoperative Creatinine Clearances on Postoperative Oxygenation in Coronary Artery Bypass Grafting: A Cohort Study

 End-stage kidney disease has a high prevalence in patients undergone Coronary Artery Bypass Grafting (CABG) and could cause a wide spectrum of morbidities, due to deep water and electrolyte or acid-base impairments. The aim of this study was to assess the effect of low Creatinine Clearances (ClCr) on arterial oxygenation defect, as common post-CABG morbidity. The study was conducted as a prospective cohort, the pure on pump CABG patients were grouped based on their preoperative ClCr to groups A (ClCr≥60) and B (ClCr<60). Postoperatively, the PaO2/FiO2 values in 1 hour after ICU admission and 4 hours after extubation, intubation time duration, duration of ICU stay and high concentration oxygen demand were compared. Among 229 patients who remain in the study, 121 were in group A, and 108 in B group. Except for age, weight, height, BMI, and pump time, other demographic and independent variables were similar between two groups. The higher values of PaO2/FiO2 and PaO2, 1 hour after ICU admission and 4 hours after extubation in group B, were not statistically significant, while SpO2 value, 1 hour after ICU admission was higher in group B (98.19±1.37) in compare with group A (97.78±1.57) (P=0.040). Intubation time duration (10.85 in A vs. 12.79 in B; P=0.306), duration of ICU stay (39.04 in A vs. 43.09 in B; P=0.114) and high concentration oxygen demand (2.5% in A vs. 3.8% in B; P=0.089) were similar between groups of study. Lower Preoperative ClCr values do not deteriorate post-CABG arterial oxygenation

Acute Respiratory Distress Syndrome Diagnosis after Coronary Artery Bypass: Comparison between Diagnostic Criteria and Clinical Picture

Acute Respiratory Distress Syndrome (ARDS) is a potential complication of cardiac surgery, given that patients undergoing CABG frequently have hypoxemia and pulmonary dysfunction during initial hours after surgery. Thus, ARDS criteria in these patients are more likely to be positive while these criteria may not match the patient`s clinical picture. We aimed to investigate frequency of rapid onset hypoxemia in Pressure of Arterial Oxygen to Fractional Inspired Oxygen Concentration (PaO2/FiO2) less than 200 and diffuse pulmonary infiltrates as two diagnostic criteria forwards and compared these criteria with the clinical picture of the patients after Coronary Artery Bypass Graft (CABG) in this study. The study was prospective case series which carried out in about six months. All patients admitted to intensive care unit of Tehran Heart Center, who had undergone CABG on cardiopulmonary pump (CPB) recruited in the study. After considering inclusion criteria, age, sex, duration of intubation, arterial blood gas and chest radiography, on 24 hours and 48 hours after admission to the ICU were recorded. Then, patients with rapid onset of hypoxemia (PaO2/FiO2≤200mmHg) and diffuse pulmonary infiltrates and without sign or symptoms of obvious heart failure (probable positive ARDS cases) criteria were recorded and comparison between these probable positive cases with clinician`s clinical diagnosis (blinded to the study) was performed. In this study, a total of 300 patients after on-pump coronary artery bypass surgery were included. Postoperatively, 2 (0.66 %) in the 24 hours and 4 (1.33%) patients in 48 hours after surgery were positive for the two ARDS criteria according to the checklists, but; nobody had saved persistently ARDS criteria persistently during 48 hours after surgery. At the same time, clinician did not report any case of ARDS among 300 patients. In this study patients with ARDS criteria had no significant differences in age (P.value=0.937) and sex (P.value=0.533). Duration of intubation in patients with ARDS (14.26 ± 4.25 hours) in the first 48 hours was higher but not statistically different from the group without ARDS (11.60 ± 5.45 hours) (P.value=0.236). ARDS diagnosis based on rapid onset of hypoxemia (PaO2/FiO2≤200 mmHg) and diffuse pulmonary infiltrates and without signs or symptoms of obvious heart failure criteria in patients undergoing CABG could lead to overdiagnosis or misdiagnosis in less than 24 hours follow up. We recommend following patients for more than 24 hours and revise the current ARDS criteria for CABG patients