ABSTRACT
Preoperative checking of the anesthetic equipment which is the primary responsibility of the nurse anesthetist is crucial for patient safety. There are many misconnection possibilities with circle system that can contribute to as highly as 35% of adverse anesthetic outcomes. A 32-year old man was admitted to the operating room [OR] for appendectomy. After the induction of anesthesia and beginning mask ventilation the anesthesiologist noticed that ventilation was not effective, therefore performed endotracheal intubation. The tracheal tube was connected to the Y piece and the mechanical ventilation was started by anesthesia machine. The lungs were not expanding effectively, therefore manual ventilation was began by an ambu bag. Beginning the manual ventilation the anesthesiologist realized an increased resistance against ventilation and an elevated airways pressure. The SpO2 fell to 79% and tachycardia was evident. Physical examinations were suggestive of pneumothorax that occurred within the first 4-5 minutes of starting machine ventilation. Rechecking the anesthesia machine revealed an error in the connection of the anesthesia circuit. We briefly review the current literature and give suggestions to eliminate these mismanagements in the operating room which can be life threatening
ABSTRACT
Premature rupture of membranes [PROM] is a common obstetric issue during pregnancy which might lead to serious fetal or maternal problems. Therefore, an appropriate diagnosis and management of PROM are of significant importance in patients. The aim of this study was to determine the accuracy of placental alpha microglobuline-1 [PAMG-1] test in PROM diagnosis and compare this diagnostic method with other standard tests in diagnosis of PROM. In this prospective diagnostic accuracy study, patients with symptoms of membrane rupture in 16-39 weeks of gestation were involved. Three tests including Fern, Nitrazine and PAMG-1 were performed at the same time. PROM was confirmed in 86 patients out of 100. The sensitivity and specificity were respectively 81.3% and 100% for Fern test, 93% and 92.8% for Nitrazine test, 98.9% and 92.8% for PAMG-1 test. PAMG-1 test showed higher sensitivity [98.9% with p<0.001] and accuracy [98%] compared with conventional tests. Although PAMG-1 showed a lower positive predictive value [PPV] compared to conventional tests such as Fern test [100%], it was shown to be more accurate. The accuracy of PAMG-1 test was superior to both Fern and Nitrazine test in PROM diagnosis
ABSTRACT
Many types of single-use blades are manufactured with different designs and materials. There have been several reports of difficulties in obtaining a view of the glottis with single-use laryngoscopes. The purpose of this prospective study was to compare the quickness and the success rate of endotracheal intubations with two different laryngoscope blades: disposable laryngoscope blades and reusable laryngoscope blades. The study included 200 patients aged 18 to 70 who were admitted to the operating room of the Ali Ebne Abitaleb Hospital in Zahedan. The patients were randomly divided in two groups. Disposable laryngoscope blades were used for the first group and reusable laryngoscope blades were used for the second group. The endotracheal intubation duration and the failure rate of the intubation were assessed in the two groups. No failures and prolongations of intubations were found in the reusable laryngoscope blades group compared with 21% incidence of prolonged intubations and 14% incidence of failed intubations in the prolonged intubations group which led to change of the laryngoscope by the anesthetists [P<0.05]. The single-use laryngoscope blades appear to be efficient devices because they do not modify the ease of endotracheal intubation in most cases. Nonetheless, for difficult intubations it is advised to maintain conventional laryngoscopes in reserve