[Evaluation of patient satisfaction with anesthesia care]

The assessment of patient satisfaction with anesthesia, the balance between expectations and perception of what was received, is an essential component of continuous quality improvement in anesthesiology. In our center there have been few studies conducted in the anesthesia field, which have assessed patient's satisfaction. In this prospective study we have evaluated patient satisfaction with anesthesia in patients 24 h after surgery. This study was performed in Sina hospital in Tehran, Iran on patients aged more than 18 yr. They all underwent elective surgical procedures with anesthesia. One of the anesthesia staff members took the interview one day after surgery and asked the patients questions for the structured questionnaire designed to measure patient satisfaction with anesthesia. At the same time, some specific questions were also asked to find factors that could be associated with such satisfaction. The data was gathered from 500 patients [mean age: 41 +/- 16 yr; and males: 65.2%]. The overall satisfaction [complete and relative] was high [98.8%]; although 6 patients [1.2%] were dissatisfied with their anesthesia care. After analysis of several factors related to the patients' surgery and anesthesia, a strong relation was found between spinal anesthesia and satisfaction [p=0.003].There was not any relation between age, gender, education, duration of anesthesia and kind of surgery with patients' satisfaction. Our study found that patient satisfaction with anesthesia was very high in our center and the only factor that increased patient's satisfaction was spinal anesthesia

Impact of subcutaneous infiltration of 0.5% bupivacaine on postoperative C-reactive protein serum titer after craniotomy surgery

Tissue injuries may provoke neuro-hormonal response which in tum may lead to release of inflammatory cytokines. We hypothesize that block of afferent sensory pathways by infiltration of 0.5% bupivacaine in the scalp may decrease neuro-hormonal response in the neurosurgical patient. After obtaining informed consent, forty ASA physical statuses I, II, or III patients between the ages of 18 and 65 years were emolled randomly into two equal groups to receive either 20 ml of 0.5% bupivacaine [group A] or 20 ml of 0.9% normal saline as a placebo [group B] in the site of pin insertion and scalp incision. As the primary outcome we checked serum C-reactive protein [CRP] levels before implementation of noxious stimulus, 24h, and 48h after the end of surgery to compare these values between groups. In addition, mean arterial pressure [MAP] and heart rate [RR] were checked at baseline [after the induction of anesthesia], one minute after pin fixation and 5, 10, and 15 minute after skin incision and the recorded values were compared between groups. No significant difference was found between serum CRP levels of the two groups. Comparison of mean HR between groups shows no significant difference. The mean of MAP was significantly lower in the group A in comparison with the group B [p< 0.001]. The results of this study confirm that 0.5% bupivacaine scalp infiltration before skull-pin holder fixation and skin incision could not decrease post-operative C-reactive protein level

[Evaluation of oral clonidine effects on prevention of post-anesthesia shivering]

Shivering is a common post anesthesia complication. Intravenous Clonidine administration at induction of anesthesia is a useful drug for decreasing of incidence and severity of post-anesthesia shivering. As Clonidine injection can induce side effects therefore we evaluated the oral Clonidine premedication on post-anesthesia shivering. In a RCT, 60 adult patients in ASA class 1 and 2 scheduled for cholecystectomy were assigned to 2 groups. 2 hours before anesthesia, 0.2 mg oral Clonidine was administrated and to the other group placebo was administered. Surgery room temperature was adjusted for 21-23[degree][c]. At the end of the anesthesia, the patients' shivering was evaluated in the recovery room by "Crossley andMahajan shivering score". There was no difference at decrease of SpO2 and H.R. and MAP between 2 groups. There was no difference in average time of emergence between 2 groups. Overall 75% of the patients shivered after anesthesia. Median shivering score in clonidine group was 1.97 and in placebo were 2.87. It became revealed that there was clear difference at shivering score between 2 groups [less severe or generalized shivering patients in test group]. 0.2 mg Clonidine tablet, 2 hours before anesthesia is similar to injecting drug and is effective in prevention of post-anesthesia shivering but its complication is less. Lack of difference at hemodynamics and SpO2 and emergence in our study may be due to slow absorption of oral Clonidine

Bonfils fiberscope: intubating conditions and hemodynamic changes without neuromuscular blockade

To compare intubating conditions and hemodynamic changes between Bonfils Intubation Fiberscope and Macintosh laryngoscopy without administering neuromuscular blocking drugs [NMBDs]. In this randomized controlled trial, 80 male and female patients, scheduled for elective surgery, aged 15 to 60 years, ASA class II or I, non-obese, non smokers, without anticipated difficult intubation; were randomly allocated into two groups of 40: Bonfils and Macintosh. Following adequate hydration and preoxygenation, midazolam 0.03 mg.kg[-1] was administered, followed by intravenous alfentanil 20 microg.kg[-1], lidocaine 1.0 mg.kg[-1], and propofol 2 mg.kg[-1] sequentially. Trachea was then intubated using Bonfils Intubation Fiberscope in the Bonfils group and conventional Macintosh laryngoscopy in the Macintosh group. Intubating condition, mean arterial blood pressure, heart rate, pulse oximetry, and success rate were measured. Clinically acceptable intubating condition scores did not differ significantly between the groups [P=0.465]. Compared to the baseline values, heart rate rose significantly after intubation only in the Macintosh group [P<0.001]. Although mean arterial blood pressure increased immediately after intubation in the Macintosh group [P=0.022], its post-intubation values were significantly less than baseline in both groups [P<0.001]. Intubation time took much longer in the Bonfils group [40 s] than the Macintosh group [11 s], P<0.001. In the absence of NMBDs, Bonfils Intubation Fiberscope compares well with Macintosh laryngoscopy in terms of success rate and intubating conditions, but with less mechanical stress and hemodynamic compromise and longer intubation time

Loss of consciousness secondary to lead poisoning

Diagnosis of lead toxicity could be difficult in IC setting because of overlap of signs and symptoms with other diseases. This is a report of two Iranian patients [father and son] with severe level of whole blood concentration, developing into unconsciousness

Hypertonic saline 5% vs. lactated ringer for resuscitating patients in hemorrhagic shock

Through hypertonic and isotonic crystalloids are used nowadays in resuscitating patients in hemorrhagic shock, yet there is no sufficient data in support of either. The aim of this study was to compare the hemodynamic effects of hypertonic saline 5% and lactated ringer solutions when used for the resuscitation of patients in hemorrhagic shock. In a double-blinded randomized clinical trial, sixty adult patients in hemorrhagic shock admitted to the Emergency Department of a teaching Hospital between September 2005 and September 2006, were enrolled in this study. Patients were divided into two groups, The first group received lactated ringer 20 ml/kg, and the second group received 4 ml/kg of 5% hypertonic saline infused intravenously within 10 to 15 minutes followed by lactated ringer 10 ml/kg/hr. Hemodynamic parameters were measured at hospital admission as well as every 15 minutes for an hour and the results were compared between the two groups. Gastrointestinal bleeding was the most common cause of shock. There was a significant difference between the baseline and final hemodynamic parameters [MAP, HR, CVP] in each group; however, data of the two groups did not differ significantly. The PaO[2] was higher in the lactated ringer group and there was no difference in PaCO[2] neither in each group nor between the two groups. Both hyper and isotonic crystalloid solutions can improve hemodynamic status and the blood gas measurements, similarly; however, lactated ringer is a more potent solution in improving tissue oxygenation