Risk factors of re-intubation of patients in intensive care units

Re-intubation of the trachea is one of the complications of the patients encounter with critical illness in the intensive care unit. The incidence of this complication has reported between 2% and 25%. Many risk factors contribute with this phenomenon; such as female sex, aging, narcotic and sedative drugs, etc. Re-intubation increases the duration of hospitalization, as well as pulmonary complications and mortality rate. The aim of this study was to evaluate the risk factors of re-intubation in the intensive care units [ICU]. This study was a retrospective cross- sectional study and was conducted in 2004 among the data documented 210 medical records. These records were obtained from three ICUs of AL-Zahra medical Center. Incomplete medical records were. All data was extracted and filled in speciallydesigned questionnaires. Obtained data was analyzed with SPSS software by using Chi-square and t-tests. From the 210 medical records studied, 15 patients [7.1%] were re-intubated. There was a positive correlation between re-intubation and hemoglobin when it was lees than 12 gr/dL or more than 15 gr/dL. Aging [age>65 years], hyponatermia [Na<135 meq/L], hypokalemia [K<3.5meq/L] and co-existing diseases [cardiac, renal, diabetes and hypertension] might have a role in increasing the frequency of re-intubation

effect of different concentrations of oxygen on postoperative nausea and vomiting after spinal anesthesia

Postoperative nausea and vomiting [PONV] are common complications after both general and regional anesthesia. A number of different drugs are used for prevention and treatment of PONV. However, the complications are still common. Some of the recent investigations showed that using high concentration of oxygen decreased nausea and vomiting after general anesthesia but there is no study about effects of oxygen on PONV after regional anesthesia. Therefore, in this study the effect of different doses of oxygen is studied on the nausea and vomiting of after spinal anesthesia. In this double-blinded clinical trial, 132 patients with ASA I and II [American Society of Anesthesiologyists] criteria and 15-70 years old who were scheduled to undergo elective surgery for reduction and fixation of tibia open fracture were randomly divided into three equal groups, Spinal anesthesia was performed with 0.5% bupivacaine solution and oxygen with concentrations of 30% [group 1], 50% [group 2] and 70% [group 3] has been administered during operation. The frequency of vomiting and the severity of nausea with regard to VAS [visual analogue scale] were determined. Data was analyzed by ANOVA and x2 tests with SPSS software and a P value< 0.05 is considered significant. The mean of vomiting frequency, nausea intensity and dose of metoclopramid consumption in the patients of the 3 groups were not significantly different. The result of this study revealed that the higher concentrations of oxygen didn't reduce PONV or metochlopramide consumption during and after the operation

[ study of relationship between post dural puncture headache and hemodynamic fluctuation in patients undergoing spinal anesthesia]

Most of researchers believe that post dural puncture headache [PDPH] is resulted of excessive leakage of cerebrospinal fluid [CSF] which leads to decrease intracranial pressure [ICP] or cerebral hypotension. Hemodynamic factors can alter ICP and CSF dynamics. The aim of this study was to determine the relationship between PDPH and hemodynamic fluctuation in patients under spinal anesthesia for orthopedic surgery. This prospective observational study was performed on 95 patients, candidate for leg orthopedic surgery, under spinal anesthesia through 23-gauge Quince needle. Blood pressure and pulse rate were recorded at 0 [before anesthesia], 1, 2, 4, 8 and 16 minutes after spinal anesthesia. Total intravenous fluid intake and ephedrine consumption during operation were assessed. Incidence, duration [day] and intensity [VAS] of PDPH were determined during 5 days after spinal anesthesia. Finally, correlation of hemodynamic fluctuation, fluid intake and ephedrine consumption with incidence, duration and intensity of PDPH were analyzed using Pierson and independent sample test. Results were considered meaningful if p<0.05. The overall incidence of PDPH was 33.3%. The mean severity and duration of PDPH were 5.83 +/- 2.11 [VAS] and 3.66 +/- 1.40 [day] respectively. There was no correlation between the occurrence and intensity of PDPH and presence of hemodynamic fluctuation, fluid intake and ephedrine consumption. The results demonstrate relatively high incidence of PDPH compared with other studies, which may be due to effect of many factors that alter this incidence. Although the hemodynamic parameters variation can effect on CSF dynamics and ICP, there is no correlation between hemodynamic fluctuations and PDPH. Also, the needle size and hole shape are the potent factors for producing the PDPH

Removal of laryngeal mask airway: Awake or deep anesthesia?

The aim of this study was to study the influence of depth of anesthesia [awake or deep anesthesia] and choice of anesthetic drug [halothane or propofol] on the incidence and severity of airway hyperreactivity associated with Laryngeal Mask Airway [LMA] removal. A prospective, randomized, double blind study was done in 156 ASA physical status I and II patients, aged 18-65 years, who had under gone short time elective surgery [<1 hour]. Patients were randomly assigned in one of the four subgroups: Hal-Aw [anesthesia maintenance with halothane and LMA removal in awaked state], Hal-Deep [anesthesia maintenance with halothane and LMA removal in deep anesthesia], Pro-Aw [anesthesia maintenance with propofol and LMA removal in awaked state], and Pro-Deep [anesthesia maintenance with propofol and LMA removal in deep anesthesia]. The incidence of cough and straining, bronchospasm, laryngospasm, breathholding, vomiting, oxygen desaturation, and severity of airway hyperreactivity [mild, moderate, severe] with LMA removal were evaluated. There were no significant differences in bronchospasm, larynchospasm, oxygen desaturation among four subgroups. Significant differences were in cough and straining, breath holding, vomiting, and finally severity of airway hyperreactivity among four subgroups. Depth of anesthesia didn't have any effect on incidence and severity of airway hyperreactivity but in those with propofol, they were lower than those with halothane. In short time surgery and with use of LMA, anesthesia with propofol is associated with lower incidence and severity of airway hyperreactivity than halothane