Risk factors of inadequate emergence following general anesthesia with an emphasis on patients with substance dependence history / 대한마취과학회지

Background@#This study aims to define the incidence and risk factors of both emergence agitation and hypoactive emergence in adult patients and substance-dependent patients following general anesthesia to elaborate on the risk factors and precise management of them. @*Methods@#The study recruited 1,136 adult patients who received elective surgeries under general anesthesia for this prospective observational study. Inadequate emergence was determined according to the Richmond Agitation-Sedation Scale (RASS). Emergence agitation was defined as a RASS ≥ +1 point, and hypoactive emergence was defined as a RASS ≤ –2 points. Subgroup analyses were then conducted on patients with substance dependence. @*Results@#Inadequate emergence in the post-anesthesia care unit (PACU) occurred in 20.3% of patients, including 13.9% with emergence agitation and 6.4% with hypoactive emergence. Ninety-five patients had a history of substance dependence. Compared to divorced patients, never-married and presently married patients, who underwent gynecological and thoracic surgeries, had a lower risk of agitation. Neurologic disorders, intraoperative blood loss, intraoperative morphine, and PACU analgesic drug administration were associated with increased agitation risk. Hypertension and psychological disorders, intraoperative opioids, and PACU Foley catheter fixation were associated with increased hypoactive emergence risk. Substance-dependent patients had higher risk for agitation (21.1%, P = 0.019) and hypoactive emergence (10.5%, P = 0.044). @*Conclusions@#Inadequate emergence in PACU following general anesthesia is a significant problem correlated with several perioperative factors. Patients with a history of substance dependence appear to be more at risk of inadequate emergence than the general population.

[ comparison of mallampati test in supine and sitting position in traditional approach and during phonation for predicting of difficult laryngoscopy and intubation]

Inadequate ventilation, esophageal intubation and difficult intubation are the most common adverse respiratory outcomes in patient undergoing anesthesia .The aim of this study was to compare Mallampati test in supine and sitting positions in traditional approach and during phonation for predicting difficult laryngoscopy and intubation. In this study performed in Imam Khomeini Hospital in Tehran, Iran, Mallampati test was performed on 661 patients who met the inclusion criteria for the study. The test was done in supine and sitting positions with and without phonation by a rater who was blind to Mallampati test. Subsequently, laryngoscopy view and difficult intubation were evaluated in the four aforesaid positions by Mallampati test for predicting difficult laryngoscopy and intubation. For each situations, sensitivity, specificity, positive and negative predictive values and accuracy were calculated. Overall, 28 [4.2%] patients had difficult laryngoscopy and 9 [1.4%] patients had difficult intubation. The highest sensitivity for Mallampati test in predicting difficult laryngoscopy and intubation was in supine and sitting positions without phonation, and the highest specificity was seen in sitting position with phonation. Negative predictive values were more than 95% in all different positions for Mallampati tests and the highest positive predictive value was seen in supine position with phonation. According to our findings, the highest correlation between Mallampati test and different positions in predicting difficult laryngoscopy and intubation was seen in supine position with phonation. Phonation improved Mallampati score in supine rather than sitting position

[Health related risk behaviors among high school students in Tehran, Iran]

The objectives of this study were to determine the frequency of risk behaviors in high school students. In this cross sectional study 2400 high school students in urban areas of Tehran were selected by multy stage sampling. They filled in a questionnire in clasroom. Then, data were analysed in a descriptive function. Frequency of health risk behaviors were intentional injuryis [41.5%], unintentional injuryis [88.7%], smoking cigarette [8.7%], alcohol drinking during the 30 days preceding survey [7.4%], other drug abuse [2.7%], sexual intercourse during life [20.2%], unhealthy dietery behaviors [14.7%] and physical inactivity during 7 days preeceding the survery [32.6%]. Sex differences were detected in health-risk behaviors. In high school students frequency of health-related risk behaviors were high. School personnel should work with community leaders and health care professionals to provide educational materials for students and their parents. Collaboration of school personnel and health care provider, as a team can develop the knowledge and skill necessery to help students make healthier choices

Upper lip bite test as a predictor of difficult mask ventilation: a prospective study

Oxygenation and ventilation by means of bag-mask and ambubag play a significant role in maintaining an optimal oxygen saturation of blood and hence the essence of life itself. Predicting difficulty in mask ventilation is again of paramount importance at the time of induction of anesthesia, and in emergency situations. In this study we aimed at evaluating factors that could help in predicting the difficulty of bag-mask ventilation. In a prospective study, 200 patients were allocated into two groups, 100 each. First group with a ULBT class I, and the other group with ULBT class II and III. Factors such as height, weight, gender, past history of snoring, neck circumference, Mallampati class, sternomental and thyromental distances were then evaluated in each of the patients in the two groups in order to arrive at their impact on the incidence of difficult mask ventilation. Data were analyzed using Chi-square, student t-test and Fisher's exact test depending upon the situation. A p<0.05 was considered to be statistically significant. The results revealed that negative predictive value [NPV] of ULBT class, history of snoring and neck circumference we 86%, 83%, 81%, respectively. A combination of these three predictors had an NPV of 95%. ULBT class alone was of value in predicting difficulty in mask ventilation, but a combination of the three tests significantly improved the predictive value

Succinylcholine-induced myalgia in obstetric patients scheduled for caesarean section-declofenac versus placebo patches-

Succinylcholine- induced myalgia is a minor but frequent complication. Its incidence and severity is different according to the studied population. The aim of this study was evaluation of the diclofenac patch effect on postoperative succinylcholine- related myalgia in cesarean section. The study was a prospective randomized double blind, placebo-controlled trial. One hundred twenty six participants undergoing elective cesarean section [previous cesarean section] were randomized in two equal groups [63 participants in each]: the diclofenac patch [containing 180 mg of diclofenac epolamine salt] and the placebo. Surgery was performed following rapid sequence induction of general anesthesia. All patients were paralyzed for intubation by succinylcholine [1.5 mg/kg]. Data on baseline characteristics, fasciculation, postoperative myalgia [at 12, 24 and 48 hours after operation], the need to analgesic agents, and adverse effects of diclofenac patch were collected. The basic characteristics were comparable between the two groups. The severity of fasciculation did not significantly vary between two groups. In diclofenac group, the incidences of myalgia at 12, 24 and 48 hours after operation were 23.8%, 19.1%, and 12.7% respectively versus incidences of 52.4%, 47.6%, and 44.4% respectively in placebo group. The incidence and severity of myalgia were significantly lower in patients receiving diclofenac through three evaluation periods [all p values less than 0.01]. No participants left the study because of the complications. Diclofenac patch is effective and safe in the prevention of postoperative succinylcholine induced myalgia after cesarean section

Knowledge, practice status and trends in risk factors for cardiovascular disease in inhabitants of Tehran University of medical sciences [population lab region]

Cardiovascular diseases are described as the most important health problems in developing countries which are developed in parallel with industrialization of communities. Based on the high morbidity and mortality of cardiovascular disease, this study was performed for examining the population lab inhabitants' knowledge and practice. In this cross - sectional study, 1576 inhabitants of the Population Lab Region were studied by cluster random sampling in 2002. 181 persons were selected from this population. The frequency of each cardio- vascular diseases risk factor such as; hyperlipidemia, smoking, obesity, hypertension, Diabetes, family history of heart attack, being man, stress and excitement, sedentary life style, salty food, vegetables fruits, fatty food and red meat consumption, were assessed. In addition, the population study's practice regarding controlling the risk factors of cardiovascular diseases was determined, as well. Moreover, specific questionnaire and direct interview were used for collecting data and then the gathering data was analyzed by SPSS and EPI - Info soft wares. In this study, 71.8% of people were women while 28.2% of them were men. Besides, there was a significant relationship between the people's knowledge about cardiovascular disease and the level of their education [P < 0.001]. According to the results, 65.2% of population believed that heart attack was the most prevalent cause of death in comparison with 44% of them considered car accident and 13.3% agreed with cancers. On the other hand, 74% of people used liquid oil in their food and 77.9% of them knew the side effects of unhealthy foods such as; salty food as one of the cardiovascular risk factors. The inhabitants' knowledge regarding to the risk factors of cardiovascular diseases was approximately acceptable. However, there was a significant different between their knowledge and practice. Therefore, providing suitable educational programs for improving people's nutrition, physical activity and the other relevant factors for preventing cardiovascular risk factors would be mentioned