Knowledge and attitude of Iranian parturient women towards painless labor: a qualitative survey

Few studies have addressed Iranian women's knowledge and attitude about painless labor. To assess the knowledge and attitude of Iranian women about painless labor and also about the use of pain relief methods among women attending maternity cares clinic. Qualitative survey. Obstetric Clinic of the Hafez training and medical center in South of Iran. Aug 2014 Sep 2014. 232 pregnant women participated in face-to-face interviews after selection through convenience random sampling. A self-administered questionnaire was used to collect baseline characteristics and information on their knowledge and attitude towards painless labor. We found that 28.9% of the women expressed that they did not have any information about painless labor, while 56.5%, 12.1%, 1.3%, and 1.3% had little, moderate, much, and perfect knowledge about painless labor, respectively. Also, 15% disagreed to choose one of the painless labor methods for current delivery after achieving the information on the methods of painless labor, 23.3% were indifferent, and 61.6% agreed to choose one of the painless labor methods. We found no association between the level of knowledge and age [P=0.694] and also gravidity [P=0.436]. However, the education level of women was directly associated with the level of their knowledge [P=0.028]. Also, employed women and housewives had the highest and lowest level of knowledge, respectively [P=0.002]. The level of knowledge and perception about painless labor is low among Iranian women, suggesting the need to implement a comprehensive program to inform pregnant women about the benefits and limitations of painless labor

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

Music can effectively reduce pain perception in women rather than men

Nowadays music is used to decrease pain and increase relaxation in clinical settings. It is hypothesized that music can affect women more easily than men. We assessed the effect of two types of music [Iranian folkloric and preferred music] on pain tolerance and pain rating in cold pressor test. A consecutive sample of 50 healthy Iranian medical students was enrolled. They reported pain tolerance and pain rating in cold pressor test in three different musical conditions served as the outcome measures. The results were analyzed with repeated measurement analysis of variance. Mean tolerance time was significantly higher in preferred music compared to Iranian folkloric music [F [1,48] =25.44, p=0.0001] and no music [F[1,48]=3.51, p=0.0001] conditions. There was a significant interaction when tolerance time in no music condition was compared to preferred music condition, regarding sex; Tolerance time increased more in females [F[1,48]=5.53, p=0.023]. The results also indicated that pain ratings, regardless of sex, were different in three musical conditions [F[1.7,81.34]=15.37, p=0.0001]. Music distracted attention from pain and Women can be impressed and distracted more easily by music

Evaluation of factors influencing liver function test in on-pump coronary artery bypass graft surgery

Background: Liver dysfunction during on-pump coronary artery bypass graft surgery [CABG] is a rare complication but is associated with significant morbidity and mortality. The ability to identify high-risk patients may be helpful in planning appropriate management strategies. We aimed to evaluate the factors influencing liver function tests during on-pump CABG

Methods: In 146 patients scheduled for on-pump CABG, the liver function test was done preoperatively and on the first postoperative day. Some preoperative and intraoperative risk factors were checked and then the postoperative liver function tests were compared with the preoperative ones. Probable relationships between these changes and the preoperative and intraoperative risk factors were studied

Results: A medical history of diabetes had a significant relationship with the changes in direct bilirubin. Preoperative central venous pressure had a significant relationship with the changes in aspartate aminotransferase and alanine aminotransferase. Use of intra-aortic balloon pump and duration of aortic cross-clamp were significantly related to the changes in the liver function tests except for alanine aminotransferase and alkaline phosphatase

Conclusion: It seems that the techniques for the reduction of cardiopulmonary bypass and aortic cross-clamp duration may be useful to protect liver function. We recommend that a larger population of patients be studied to confirm these findings

Severe acute hyperkalemia during pre- anhepatic stage in cadaveric orthotopic liver transplantation

A serious hazard to patients during orthotopic liver transplantation is hyperkalemia. Although the most frequent and hazardous hyperkalemia occurs immediately after reperfusion of the newly transplanted liver, morbid hyperkalemia could happen in the other phases during orthotopic liver transplantation. However, pre-anhepatic hyperkalemia during orthotopic liver transplantation is rare. This report describes one such patient, who without transfusion, developed severe hyperkalemia during pre-anhepatic phase. The variations in serum potassium concentration of the present case indicate that it is necessary to take care of the changes of serum potassium concentration not only during reperfusion but also during the other phases of the liver transplantation