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

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

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