Comparison of intravenous ranitidine with pantoprazole in decreasing gastric fluid acidity in emergency cesarean section

Peri-operative aspiration of gastric contents is a problem that causes certain respiratory problems including ARDS. Prophylaxis against aspiration of gastric contents is performed routinely in elective surgeries, but there is rare evidence on the efficacy of this method in emergency cesarean section. This is a randomized, controlled, double-blinded clinical trial. 60 parturients undergoing emergency cesarean section were randomly assigned into three groups of 20 each. They were allocated into two study and one placebo groups. The study group one and two received intravenous ranitidine [IV] 50 mg or IV pantoprazole 40 mg, half an hour before induction of GA, respectively. The placebo group was administered just 5 ml of isotonic saline half an hour before GA induction. After intubation and confirmation of endotracheal tube insertion, the gastric contents were aspirated through a nasogastric tube for evaluation of acidity and volume. A statistical difference between group one and two with the control group was observed in the acidity of gastric contents, but there was no difference in volume. Also, the PH level of gastric contents in patients receiving pantoprazole was significantly higher than the isotonic saline [p<0.001] and ranitidine groups. The difference in average level of acidity of gastric contents in patients receiving pantoprazole and ranitidine showed a marginal significance [p

Educational needs of nurses in intensive care unit for poisoned patients

Poisoned patients are at risk of impaired ventilation in many situations. The purpose of this descriptive study was to investigate the impact of educational workshops on nurses' knowledge, confidence, and attitude in taking care of poisoned patients. This descriptive study was performed on 60 nursing staff in the intensive care unit [ICU] for poisoned patients in Imam Reza [p] hospital, Mashhad, Iran. Data was gathered by a researcher-designed questionnaire. Studied scales included perceived importance and novelty of educational meeting, matching with professional and educational needs, illustration of practical and knowledge weaknesses and strength and finally satisfaction in holding regular workshops annually. Two, half day workshops were held and various items were taught with various methods. The knowledge of participants was assessed by pretests and post-tests consisting of 12 items related to workshop topics. The impact of these educational meetings was evaluated and the results were analyzed by the SPSS software. According to the results, workshops improved awareness of nurses about their weakness and strength points, professional knowledge and their interest and attention; likewise all participants had the same opinion about a strong need to hold similar workshops more than once and preferably 2 to 3 times annually. It seems that short educational courses in small groups for reviewing the old data and recent findings in the context of critical care are useful in order to promote the knowledge and skills of ICU staff in taking care of poisoned patients.

Percutaneous retrieval of a dislodged guide wire by dormia basket in a 98-year-old patient, still a safe and feasible approach

Since the first report of percutaneous retrieval of intravascular foreign body in 1964, it has been accepted as a favorite approach for intravascular foreign body removal. Various instruments such as snares, biopsy forceps, dormia basket or tip deflecting wires are available for this approach. Herein, we report percutaneous retrieval of a dislodged guide-wire by dormia basket. The Patient was a 98-year-old female who was admitted in the Intensive care unit due to confusional state. The physian incharge left the guide-wire in her subclavian vein during central venous catheter insertion. He realized his fault immediately, so he started anti-coagulation therapy and requested surgical consult. Because of the patient's high risk of surgery, the surgeon referred the patient to cardiologist for non-invasive guide wire removal. The guide wire was apprpached through femoral vein by a dormia basket [4/6 F] and it was removed without any difficulties or complications. Utilization of baskets for intravascular foreign body removal is frequently reported and has been successful with low complication rates; In addition, the low cost of the device makes it less of a burden to the patient and the hospital

[Effect of magnesium sulfate on cardiac arrhythmias after open heart surgery]

Postoperative cardiac arrhythmias are among the most common complications of cardiac surgery. The purpose of this study was to assess the effect of infusion of magnesium-sulfate on the incidence of cardiac arrhythmias especially atrial fibrillation [AF] and premature ventricular contraction [PVC] in patients undergoing on-pump coronary artery bypass grafting [CABG]. In this clinical trial 120 patients were randomly divided into two groups. In experimental group sixty patients received intravenous magnesium-sulfate 2gr at the night before operation and 2gr during operation and 30mg/kg on the first, second, third, and fourth days after surgery. In control group sixty patients underwent surgery as the routine treatment. Incidence of atrial fibrillation and premature ventricular contraction were evaluated during and after surgery. For analysis of qualitative variables, X[2] and Exact Fischer tests were used. Preoperative patient characteristics and operative variables were similar in both groups [P>0.05]. No postoperative AF was detected in the patients of magnesium group, while 4 [8.3%] patients in control group developed AF post-operatively [P=0.03]. Post-operative PVC occurred in 12 [20.7%] patients of magnesium group and in 21 [42.9%] patients of control group [P=0.02]. Infusion of magnesium sulfate during operation seems to be effective in the prevention of new episodes of AF and PVC after coronary artery bypass grafting [CABG]

[Pulmonary edema following cesarean section under spinal anesthesia: a case report]

This is a report of pulmonary edema following cesarean section under spinal anesthesia in a patient with valvular heart disease. The patient was a 38-yr old multigravida woman without history of cardiac disease. She was operated under spinal anesthesia and remained haemodynamically stable throughout the procedure. But she developed respiratory distress at the end of operation in the recovery room. The only finding in ECG of the patients was sinus tachycardia and chest X-ray revealed bilateral pulmonary edema. The result of echocardiography was suggestive of moderate to severe mitral stenosis. Diagnosis of pulmonary emboli was excluded by perfusion scan. The patient was treated with diagnosis of pulmonary edema and after two hours the patient showed some improvement. Result of the echocardiography on the next day, confirmed the diagnosis. Physical examination should be performed carefully in order to determine the proper method of anesthesia. Spinal anesthesia in patients with mitral stenosis, in particular in pregnancy may not be well tolerated and should be performed cautiously

Maternal and Fetal outcomes following open heart surgery during pregnancy

This study is aimed at evaluation fetal and maternal outcome in pregnant women with heart disease candidate for open heart surgery. In this study we evaluated adverse complications in 14 pregnant women underwent open heart surgery during three years period. Variable parameters were: age, parity; gestational age, history of cardiac surgery and medications, cardiac complications during pregnancy surgical indications of cardiac disease, fetal and maternal mortality and related complications. Mean age and gestational age were 38.4 years and 17.28 weeks respectively. Most of the patients were multiparous [71.42%] and in functional NYHA class III or IV [85.70%]. During pregnancy 71.43 percent of patients showed signs and symptoms of CHF and 64.28 percent of them had atrial fibrillation. All patients underwent emergent open heart surgery. Maternal and fetal mortality following surgery were 35.71 and 78/57 percent respectively. Cardiac Surgery during pregnancy were accompanied with high fetal and maternal mortality. Such pregnancies need to be managed by a team including obstetrician, cardiologist, anesthetist and cardiac surgeon. For best result, it is better to postpone surgery whenever possible and surgery is performed only when it was indicated. The present study demonstrates that emergency surgery, poor NYHA class, Atrial Fibrilation, unstable heart disease, poor economical cultural conditions will result in adverse outcome in mother and fetus following cardiac surgery