Does spinal analgesia have advantage over general anesthesia for achieving success in in-vitro fertilization?

Because of high psychological burden and considerable costs of in-vitro fertilization, it is greatly important to identify all factors that may influence its results. In this study, general anesthesia and spinal analgesia used for oocyte retrieval were compared in terms of success in treating infertility among couples who had undergone in-vitro fertilization at an infertility center in Tehran, Iran. This cohort study that was based on analysis of patient records at Mirza Kochak Khan Hospital, Tehran University of Medical Sciences, in 2008-2009. In this study, the status of chemical pregnancy among those who experienced general anesthesia or spinal anesthesia for in-vitro fertilization for the first time were compared, and the possible effects of clinical and laboratory factors using logistic regression models were considered. Considering the number of transferred embryos, underlying cause of infertility and fetus grade, it was found that practicing spinal anesthesia is significantly related to increased chance of chemical pregnancy [adjusted Odds Ratio=2.07; 95% CI: 1.02,4.20; p=0.043]. According to analysis of recorded data in an infertility treatment center in Iran, it is recommended to use spinal anesthesia instead of general anesthesia for oocyte retrieval to achieve successful in-vitro fertilization outcome. This can be studied and investigated further via a proper multicentric study in the country.

Can a new antiseptic agent reduce the bacterial colonization rate of central venous lines in post-cardiac surgery patients?

Central venous [CV] catheters play an essential role in the management of critically ill patients in the Intensive Care Unit [ICU].CV lines are, however, allied to catheter-associated blood stream infections. Bacterial colonization of CV lines is deemed the main cause of catheter-associated infection. The purpose of our study was to compare bacterial colony counts in the catheter site before CV line insertion in two groups of post-cardiac surgery patients: a group receiving Sanosil [an antiseptic agent composed of H[2]O[2] and silver] and a control group. This interventional prospective double-blinded clinical trial recruited the patients in three post-cardiac surgery ICUs of a heart center. The participants were divided into interventional [113 patients] and control [136 patients] groups. Sanosil was added to the routine preparation procedure [Chlorhexidine bath one day before and scrub with Povidone-Iodine just before the CV line insertion]. After the removal of the CV lines, the catheters tips were sent for culture and evaluation of colony counts. Catheter colonization occurred in 55 [22.1%] patients: 26 [23%] patients in the Sanosil group and 29 [21.3%] in the control group; there was no significant statistical difference between the two groups [p value = 0.75, RR = 1.05, 95%CI: 0.76-1.45]. The most common organism having colonized in the cultures of the catheter tips was staphylococcus epidermis: 20 cases in the control group and 16 cases in the intervention group. Catheter colonization frequently occurs in post-cardiac surgery patients. However, our results did not indicate the effectiveness of adding Sanosil to the routine preparation procedure with respect to reducing catheter bacterial colonization

effect of meperidine on peripartum breastfeeding and neonatal weight

To evaluate the effect of Meperidine, commonly administered for labor analgesia, on newborn weight and peripartum breastfeeding during two months after delivery. This pilot cohort study was conducted between October 2010 and October 2011 at the Women Hospital of the Tehran University of Medical Sciences. In this study, we examined the effects of meperidine on breastfeeding and neonatal weight. A total number of 184 full term pregnant women, planned to deliver at this center [normal vaginally delivery or cesarean], participated in this study. The study group included the women who received meperidine in peripartum time to be compared with a control group who did not receive any opioid. Meperidine was administrated to them based on their peripartum breastfeeding behaviour and baby weight, two month after delivery. Of the 184 woman recruited to the trial, 38 women had normal vaginal delivery and 146 had ccesarean. Within the first two-month, 4% of mothers in control group and 11% of meperidine group used formula. However, this differences were not statistically significant [p value= 0.07]. Furthermore, baby weight distribution was not statistically different between two groups. The inhibitory effect of using Meperidine on peripartum breastfeeding and weight of newborn in the first two months was not statistically significant in this study. More research is needed to clarify the association between meperidine and peripartum breastfeeding

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

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. 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. 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. The problem-based method increased our residents' self-evaluation score of their own CPCR knowledge and skills

Effect of hypertonic saline infusion versus normal saline on serum ngal and cystatin c levels in patients undergoing coronary artery bypass graft

Acute kidney injury [AKI] is a common and life-threatening complication following coronary artery bypass graft [CABG]. Neutrophil gelatinase-associated lipocalin [NGAL] and Cystatin C have shown to be good predictive factors for AKI. Recently, there has been a growing interest in the use ofhypertonic saline in cardiac operations. The purpose of this study was to evaluate the prophylactic anti-inflammatory effect ofhypertonic saline [Group A] infusion versus normal saline [Group B] on serum NGAL and Cystatin C levels as the two biomarkers of AKI in CABG patients. This randomized double-blinded clinical trial recruited 40 patients undergoing CABG in Tehran Heart Center, Tehran, Iran. After applying exclusion criteria, the effects of preoperative hypertonic saline [294 meq Na] versus normal saline [154 meq Na] infusion on serum NGAL and Cystatin C levels were investigated in three intervals: before surgery and 24 and 48 hours postoperatively. The probable intraoperative or postoperative confounders, including pump time, cross-clamp time, heart rate, systolic and diastolic blood pressures, central venous pressure, arterial pH, partial pressure of arterial oxygen, fraction of inspired oxygen, blood sugar, Na, K, Mg, hemoglobins, white blood cells, hematocrits, and platelets, were recorded and compared between the two groups of study. The study population comprised 40 patients, including 25 [62.5%] males, at a, mean age +/- SD of 61.7 5 +/- 8.13 years. There were no statistically significant differences between the patients' basic, intraoperative, and postoperative characteristics, including intraoperative and postoperative hemodynamic variables and supports such as inotropic use. Intra-aortic balloon pump use and mortality were not seen in our cases. Three patients in the normal saline group and one patient in the hypertonic saline group had serum NGAL levels greater than 400 ng/ml. Moreover, 10 patients in Group A and 17 patients in group B showed a rise in serum Cystatin C levels above 1.16mg/dl. Patients with AKI had significantly elevated NGAL and Cystatin C levels [p value < 0.001], but there were no significant differences in the decrease in the NGAL level in the hypertonic saline group versus the normal saline group [230.91 +/- 92.68 vs. 239.74 +/- 116.58 ng/ml, respectively; p value = 0.792], or in the decrease in the Cystatin C level in the hypertonic saline group versus the normal saline group [1.05 +/- 0.26 vs. 1.06 +/- 0.31, respectively; p value = 0.874]. Pre-treatment of CABG patients with hypertonic saline had no significant effect on serum NGAL and Cystatin C levels compared to the normal saline-receiving group. Our present data, albeit promising, have yet to fully document outcome differences

new method for extubation: comparison between conventional and new methods

Extubation is associated with the risk of complications such as accumulated secretion above the endotracheal tube cuff, eventual atelectasia following a reduction in pulmonary volumes because of a lack of physiological positive end expiratory pressure, and intra-tracheal suction. In order to reduce these complications, and, based on basic physiological principles, a new practical extubation method is presented in this article. The study was designed as a six-month prospective cross-sectional clinical trial. Two hundred fifty-seven patients undergoing coronary artery bypass grafting [CABG] were divided into two groups based on their scheduled surgery time. The first group underwent the conventional extubation method, while the other group was extubated according to a new described method. Arterial blood gas [ABG] analysis results before and after extubation were compared between the two groups to find the effect of the extubation method on the ABG parameters and the oxygenation profile. In all time intervals, the partial pressure of oxygen in arterial blood / fraction of inspired oxygen [PaO[2] / FiO[2]] ratio in the new method group patients was improved compared to that in the conventional method; some differences, like PaO[2] / FiO[2] four hours after extubation, were statistically significant, however [p value = 0.0063]. The new extubation method improved some respiratory parameters and thus attenuated oxygenation complications and amplified oxygenation after extubation.

Continuous sedation-analgesia delays diagnosis of compartment syndrome in a patient with intra-aortic balloon pump

Compartment syndrome is a rare, devastating complication of coronary artery bypass grafting [CABG] and intra-aortic balloon pump [IABP]. Prompt diagnosis is based on symptoms and signs and is paramount for limb rescue. This report describes a CABG patient with IABP in whom receiving continuous analgesia-sedation obscured the symptoms of compartment syndrome

Post dural puncture headache after cesarean section, a teaching hospital experience

This prospective study examined the frequency of Post-Dural Puncture Headache [PDPH] in 361 parturient women undergoing spinal anesthesia for cesarean section in a teaching hospital of Tehran University of Medical Sciences. Spinal anesthesia was performed using 25 gauge Quincke needles in all women. Patients were followed up to determine incidence of PDPH and then tried to compare those with or without PDPH using statistical methods to determine risk factors of PDPH. The overall incidence of PDPH was 10.8 percent in this study. In terms of probable risk factors which were compared between the two groups of patients, no statistically significant differences were found. The incidence of PDPH in our study was higher than studies which used pencil - tipped needles and we determined that the occurrence of PDPH is not associated to some factors like the previous history of nonspecific headache, Body Mass Index, age, type of local anesthetic, previous history of PDPH, experience of operator, history of habitual tea and coffee drinking

effect of ephedrine on fetal outcome in treatment of maternal hypotension caused by spinal anesthesia during cesarean section

Spinal anesthesia causes hypotension which is a physiologic component during cesarean section. Ephedrine is used for prevention and treatment of maternal hypotension during spinal anesthesia. The aim of this study is to evaluate the effect of transient hypotension which is normalized with ephedrine on fetal outcome. Eighty women with singleton pregnancies scheduled for elective cesarean section under spinal anesthesia were divided to two groups. The control group was women with normal BP, and case group were women with hypotension who received ephedrine. Two groups were compared for these variables: maternal BP and HR, nausea and vomiting, neonate Apgar and fetal cord blood gases. No difference was found between two groups for variables of age, BMI, weight, height, mean BP, mean HR, serum volume, fetal Apgar in 1 and 5 min and fetal cord fetal blood gases. Dosage of oxytocin used was significantly different between two groups [P-value = 0.003]. Transient hypotension which is treated by ephedrine does not have any effect on acid base situation of baby and treatment of hypotension with ephedrine in pregnant women is a safe procedure