[Effects of intravenous midazolam premedication on postoperative nausea and vomiting after cataract surgery under general anesthesia]

Background: postoperative nausea and vomiting is still a common and major complication after general anesthesia, which may delay post-anesthetic care unit [PACU] discharge, prolong hospital stay and thus increase the cost of hospitalization. Several drugs and techniques have been shown to be effective in reducing postoperative nausea and vomiting. In this study the effects of premedication with Intra venus midazolam on the incidence and severity of postoperative nausea and vomiting was investigated in a sample of adult patients undergoing Extra Capsular Cataract Extraction under general anesthesia

Material and Methods: one hundred adult patients undergoing general anesthesia for Cataract surgery were randomly divided into two groups to receive either midazolam [0.025mg/kg] or a same volume of normal saline intravenously two minutes prior to induction of anesthesia. Incidence and severity of Postoperative nausea and vomiting and the total amount of administered metoclopramide during the first postoperative day [24hours] were compared between the two groups

Results: there were no differences between the two groups regarding the age, sex, body mass index, NPO time, preoperative anxiety, and severity of post operative pain. Severity of nausea and frequency of vomiting were significantly lower in midazolam group during the first 24 hours after surgery compared with placebo group [nausea: 1.14 +/- 1.42 of a ten point visual analog scale vs. 3.18 +/- 2.43 in placebo group, P<0.05], and [vomiting: 0.08 +/- 0.340 vs. 0.8 +/- 0.948 in placebo group, P<0.05]. Midazolam group received a significantly less amount of metoclopramide during the first postoperative day [0.8 +/- 2.7 mg vs. 2.2 +/- 1.4 mg in placebo group; P<0.05] but recovery time in midazolam group was slightly longer than placebo group [20.80 +/- 4.88 minutes vs. 16.20 +/- 3.43; P<0.05]

Conclusion: the results of this study suggest the effectiveness of intravenous midazolam premedication to reduce the incidence and severity of postoperative nausea and vomiting

[Translation and validation of the Amsterdam preoperative anxiety and information scale [APAIS] for Iranian population]

Although anesthesia and surgery have become safer and more successful than ever before, preoperative anxiety is still a common problem. In this study, we translated and validated the Amsterdam Preoperative Anxiety and Information Scale [APAIS] for Iranian population. We first translated the English version into Farsi, then translated back into English. The translation to English was authorized by the correspondent author of English version [Tim Wysocki].The questionnaires were completed by 130 patients with A.S.A I and II scheduled for elective outpatient surgeries. They also completed 20-item Spielberger's State Anxiety Inventory [STAI-State] questionnaire concurrently as a gold standard for evaluation of preoperative state anxiety. Cronbach's alpha was 0.84 for the anxiety scale and 0.82 for the need-for-information scale. The correlation between the anxiety items of the APAIS and the STAI-State was high [0.68] and the correlation between the information items and the STAI-State were intermediate [0.50]. Factor analysis with oblique rotation revealed two factors which explained 72% of the total variance: anxiety and need-for-information. Female sex and need-for-information were independently associated with preoperative anxiety. Anxiety was significantly higher in females [9.30 +/- 4.12] than males [5.8 +/- 2.30] [P < 0.001]. Assuming APIAS for anxiety equal or more than 11 as cut-off point, 21% of our study patients were anxious and 68% of our patients had a positive-information attitude. Farsi version of APAIS is a valid and reliable instrument for evaluation of preoperative anxiety and information requirement. Gender and information requirement are independently associated with preoperative anxiety

[Chronic incisional pain after open appendectomy]

Although appendectomy is the most common emergency abdominal surgery, there is no epidemiologic study on chronic pain after open appendectomy. The aim of this study was to evaluate the incidence and possible risk factors of chronic pain following this common surgical procedure. In this cross-sectional survey, a questionnaire was completed regarding the pain at the surgical site by calling available patients who had undergone open appendectomy from 1999-2004 in a hospital in Fasa. The patients records were checked for the results of pathology. Out of 1130 patients operated by open appendectomy, 155 were available. The mean time left after appendectomy was 28 months. At the time of study, 41 [26%] patients still had pain at the site of operation and 9.85% of them had severe pain at rest and 22% suffered from severe pain during daily activities. Chronic pain was significantly more common among patients who had the memory of severe acute post-operative pain and there was no significant difference in the chronicity of pain according to age, sex and positive appendectomy. Chronic post-appendectomy pain is provalent. It is more common in patients with severe acute post-operative pain but it seems not to be related with age, sex, and positive appendectomy

Comparison of basic life support [BLS] video self-instructional system and traditional BLS training in first year nursing students

For several years, educators have criticized the lecture-based approach to teaching and learning. Experts have rightly stressed on acquisition of a number of critical skills rather than focusing on lectures. To compare students' performance after self-education with VCD and manikin, with the performance after standard BLS training. In this randomized controlled study, twenty first-year nursing students were divided into two groups randomly, and were provided with basic life support [BLS] instruction either in the traditional format of lecturing or with VCD and manikin without tutor The students' Performance was evaluated on a manikin with a checklist including all steps in BLS. With traditional instruction, students' mean score was 42.2 +/- 3.91, while it was 46.3 +/- 3.86 with self-education, showing no significant difference. In nursing students with no previous BLS training, access to VCD and manikin facilitates immediate achievement of educational objectives similar to those of a standard BLS course. Self-learning BLS with VCD should be enhanced with a short period of hands-on practice