effect of intraoperative restricted normal saline during orthotopic liver transplantation on amount of administered sodium bicarbonate

Background: Severe metabolic acidosis occurs during orthotopic liver transplantation [OLT] particularly during the anhepatic phase. Although NaHCO[3] is considered as the current standard therapy, there are numerous adverse effects. The aim of this study was to determine whether the restricted use of normal saline during anesthesia could reduce the need for NaHCO[3]

Methods: In this study we enrolled 75 patients with end-stage liver disease who underwent OLT from February 2010 until September 2010 at the Shiraz Organ Transplantation Center. Fluid management of two different transplant anesthetics were compared. The effect of restricted normal saline fluid was compared with non-restricted normal saline fluid on hemodynamic and acid-base parameters at three times during OLT: after the skin incision [T1], 15 min before reperfusion [T2], and 5 min after reperfusion [T3]

Results: There were no significant differences in demographic characteristics of the donors and recipients [P>0.05]. In the restricted normal saline group there was significantly lower central venous pressure [CVP] than in the non-restricted normal saline group [P=0.002]. No significant differences were noted in the other hemodynamic parameters between the two groups [P>0.05]. In the non-restricted normal saline group arterial blood pH [P=0.01] and HCO[3] [P=0.0001] were significantly less than the restricted normal saline group. The NaHCO[3] requirement before reperfusion was significantly more than with the restricted normal saline group [P=0.001]

Conclusion: Restricted normal saline administration during OLT reduced the severity of metabolic acidosis and the need for NaHCO[3] during the anhepatic phase

Cardiovascular health knowledge of patient attendants in southern of Iran, Shiraz

Knowledge about coronary artery disease and it's risk factors is a very important factor in prevention of ischemic heart disease. The aim of this study was to investigate knowledge of patient attendants about coronary artery disease and its risk factors in southern of Iran; Shiraz. Cross sectional study. Shiraz University of Medical Sciences. 800 patient attendants [persons accompanying patients] selected randomly and divided into two groups [study and control] each including 400 patient attendants. Face to face interview was done and knowledge was measured by correct answers to our standard questionnaire. The median knowledge score was 6.89 for study group and was 2.82 for control group out of a possible maximum of 15. Majority of respondents in study group could identify up to three risk factors for coronary artery disease, but in control group could identify only one risk factor. About 5.8% in study group and 37.5% in control group were not able to identify even a single risk factor for coronary artery disease. According to our results there is a big gap in knowledge about coronary artery disease and it's risk factors in our population. It means that more educational programs are needed to prevent the increasing rate of coronary artery disease

Survey on causes of hemolysis in Glucose-6-Phosphate Dehydrogenase [G6PD] deficient pediatric patients

Glucose-6-phosphate dehydrogenase [G6PD] deficiency is the most common enzymatic disorder of red blood cells and more than 400 million people are affected in the world. Our objective was to evaluate the causes of hemolysis in G6PD deficient hospitalized patients. This retrospective study was done on 196 G6PD deficient patients during 2007-2010. They were between 1-13 years of age who were admitted to Shahid Dastgheib hospital of Shiraz in Iran for management of hemolysis crisis. Patients with hemolysis but without any documents of G6PD deficiency were excluded. The prevalence of G6PD deficiency was higher in boys. Seasonal variations also affect hemolysis in these patients, peak incidence was observed in spring fallowed by autumn, winter and summer respectively. Ingestion of fava beans was the major cause where as infections, drugs, exposure to henna, pollen of fava beans and diabetic ketoacidosis were the other causes of hemolysis. The major cause of hemolysis is ingestion of fava beans fallowed by infections and oxidative drugs consumption in this region. So, awareness of G6PD deficient subjects about these factors and an early treatment of infection is very important for prevention of hemolysis in these patients

effect of addition of low dose atracurium to local anesthetic in retrobulbar block for cataract surgery

Addition of some neuromuscular blockers to local anesthetics proved to be effective in improving the quality of anesthesia in different regional techniques. This study was carried out to determine whether the addition of low-dose atracurium to a local anesthetic has any effect on the onset and duration of akinesia in retrobulbar block. This study was conducted on sixty-four unpremedicated, ASA I or II patients scheduled for cataract surgery under local anesthesia. The patients were assigned to one of the two treatment groups in a randomized, double-blind manner. The case group received 2 ml of 2% lidocaine [40 mg] and 0.5 mL atracurium [5 mg]. The control group received 2 ml of 2% lidocaine [40 mg] and 0.5 ml 0.9% NaCl. The onset of akinesia [the inability to move the eye in all four directions] was scored as 0 to 2: 0, no akinesia; 1, partial akinesia; and 2, complete akinesia. The onset and duration of akinesia and also adverse effects and complications of each method were recorded throughout the study. In 4 out of 64 patients, complete akinesia was not achieved and statistical analysis was done on 60 others with complete akinesia. With regard to age, sex, weight, and duration of the surgery, there were no significant differences between the case and control groups. The onset of complete akinesia was quicker and duration longer in the case group than in the control group. The onset of complete block was 4.7 +/- 1.1 minutes in the case group and 6.9 +/- 0.96 minutes in the control group [P<0.001]. The duration of akinesia was 104.07 +/- 17.6 minutes in the case group and 87.1 +/- 16.2 minutes in the control group [P<0.001]. This study demonstrated that atracurium had a local action on the extraocular muscles. It shortened the onset period of retrobulbar block, prolonged its duration, and provided excellent surgical conditions without any specific complications

simple way to achieve the routine position for phacoemulsification in a patient with marked thoracic kyphosis

To introduce a simple way for achieving the routine position for phaco-emulsification in a patient with a marked thoracic kyphosis. A 74-year-old man with marked thoracic kyphosis and visually significant cataracts presented for surgery; he was unable to lie flat due to the severe deformity. The best possible surgical position was achieved by placing a chair with an adjustable top between a standard operating table and another small table. The wheels of the table and the chair were securely immobilized by adhesive tape. The space between the operating table and the small table was filled with rolled towels and covered with a blanket. The patient lay down with his head placed on the small table while the kyphotic portion of his thorax fitted into the free space between the small table and the operating table. The variable top of the chair allowed adjusting the space in order to accommodate his kyphotic thorax. Successful temporal approach phacoemulsification was performed comfortably while the patient lay in the standard position required for cataract surgery. It is possible to position patients with thoracic problems on a standard operating table using readily available equipment in the operating theater