Efficacy of the iso-gard high efficiency particulate airborne [HEPA] light breathing filter in preventing cross contamination through anesthesia breathing circuits

Respiratory infections are among the most important causes of nosocomial infection in the postoperative pehod and are associated with prolonged hospitalization and increased costs. Respiratory pathogens can be transmitted through breathing circuits used to provide anesthesia, therefore, appropriate decontamination of respiratory equipment is essential to provide better patient care. The use of appropriate single-use filters to isolate the anesthetic circuit for each patient in order to maintain sterility and to prevent cross infection, may appear prudent for patient safety and cost containment. As the efficacy and effectiveness of bacteria! filters for breathing circuits or anesthesia ventilators to prevent cross infections have not been fully investigated in the clinical setting. Therefore the purpose of this study was to evaluate, in the usual clinical anesthesia setting, the bacterial filtration efficacy of an anesthesia-breathing filter. A new sterile Iso-Gard High Efficiency Particuiate Airborne [HEPA] light breathing filter was asepticaily connected to the Y-piece of a sterile disposable clear anesthesia breathing circuit before the induction of general anesthesia. At the end of anesthesia, the breathing filter was removed from the Y-piece. Both sides of the breathing filter [patient and circuit] were sampled for bacterial culture, immediately plated on three growth media: Chocolate, Blood and MacConkey agar, incubated at 37'C for 24 - 48 hours. Bacterial identification was conducted using standard microbiological procedures. Bacterial cultures were negative on both sides of the filter membrane of 43/50 fitters studied. Cultures were positive on the patient side of five filters. In one of those nearly the same bacteria were found on both the circuit side and the patient side of the filter. Cultures were positive on circuit side of two filters. Therefore these data indicate a clinical effectiveness of 98% [confidence interval, Cl 95%, 94.12-101.88%], and an in vivo nitration efficacy of 80% [C.I. 95%, 74.57-85.43%]. Thus this study concluded that; using a sterile Iso-Gard HEPA light breathing filter for every patient while reusing the anesthesia breathing circuit would result in a cross contamination rate of the breathing circuit in two every one hundred cases

Comparison between the effect of nefopam, ondansteron or meperidine in preventing post anesthetic shivering

This study was carried on 80 adult patients undergoing elective surgery of more than 60min duration to compare the efficacy of nefopam, ondansetron or meperidine in preventing post-anesthetic shivering. All patients were allocated blindly into 4 groups according to drugs given. 0.15 mg/kg nefopam hydrochloride, 4 mg ondansetron, 0.4 mg/kg meperidine and10 ml saline were given intravenous before endotracheal extubation in G I, II, HI and IV respectively The results of the study showed that; core esophageal temperature [COT] and finger tip temperature [FTT] decreased significantly in all groups during intra- and postoperative times compared to preoperative values. Both readings did not significantly change at postoperative times when four groups compared to each other. Post anesthetic shivering was assessed by Wrench scale [0-4]. The highest incidence of shivering was manifested ingroup IV versus groups I, II and III up to 4 h postoperative. The least incidence of shivering was manifested in group III versus groups I, II and IV at 5 and 15 min postoperative. Arterial oxygen content and venous oxygen content decreased significantly in group IV compared to groups I, II and III at all times of measurements postoperative. Meanwhile both readings increased significantly in group III compared to groups I, II and IV at Sand 15 minutes postoperative and they were still the highest values in group III compared to groups I and IV at 60 minutes postoperative. Oxygen extraction ratio [O2 ER] and blood lactate level [BLL] increased significantly in group IV compared to groups I, II and III at 5, 15 and 60 minutes postoperative and O2 ER decreased significantly in group III compared to groups I, II and IV at 15 and 60 minutes postoperative. Post operative pain score was assessed using VAS. The highest incidence of pain was manifested in groups II and IV versus groups I and III and the least incidence of pain was manifested in group Ill versus groups II and IV up to 6 hours post operative. At 24 hours postoperative the highest incidence of pain was manifested in group IV versus groups I, II and III. In conclusion nefopam, ondansetron and meperidine reduced the incidence of PAS with varying degrees. Meperidine was more effective in controlling PAS, and maintaining tissue oxygenation than nefopam, and ondansetron. This study recommended, the prophylactic use of meperidine at the end of surgery to decrease incidence of PAS, further studies to evaluate the minimal effective dose of nefopam and ondansetron in preventing PAS and to evaluate the combination of pharmacological and nonpharmacological methods for prevention of PAS

effect of magnesium sulfate clinical, chemical, and immunological responses to surgery

The present study was carried out on 30 adult patients scheduled for elective cholecystectomy under the effect of general anesthesia. Patients were randomly allocated to two equal groups. Patients in group I [GI], received 40-ml intravenuos [i.v.] saline before the induction of anesthesia, Patients in group II [GII], received 60 mg/kg i.v. magnesium sulfate 10% as loading dose before induction of anesthesia then 1 g/h magnesium sulphate 10% for 10 hours starting at the time of induction of anesthesia. The results of this current study showed that, the administration of fentanyl or in combination with magnesium before induction of anesthesia can attenuate the hemodynamic response to tracheal intubation and surgery. There was a significant increase in fasting blood sugar in the studied groups immediately post operative compared with pre operative values. After 24 hours, there was a persistent impairment of glucose utilization in GII. Magnesium decreased significantly in GI and increased significantly in GII immediately postoperative compared with pre operative values. It returned nearly to preoperative values after 24 hours in the studied groups. There was a significant hypokalemia immediately postoperative in GII. Triglycerides decreased significantly at 24hours postoperative compared with preoperative values in the studied groups. Cholesterol decreased significantly immediately and 24h postoperative compared with preoperative value in GII. Cortisol level decreased significantly at 24h postoperative in GII compared with GI. While epinephrine level decreased significantly immediately postoperative in GII compared with GI. There was no significant difference in norepinephrine level between the studied groups. Soluble interleukine 2 receptors did not significantly change at any time postoperative in the same group or in comparison between the two studied groups. In conclusion combination of magnesium and fentanyl before induction of anesthesia can attenuate the hemodynamic response to tracheal intubation and surgery. Hypomagnesemia is a frequent finding immediately postoperative. Magnesium sulfate significantly reduced cholesterol levels up to 24h postoperative but cannot attenuate hyperglycemic response to surgery. Magnesium sulfate can attenuate epinephrine and cortisol release in response to surgery immediately and at 24h post operative respectively. Therefore the co administration of magnesium with fentanyl before anesthesia is highly recommended to attenuate the hemodynamic, endocrinal and metabolic responses to surgery