فیروزه نادری

Background and

Recommended treatment for patients with carotid stenosis, is Carotid Endarterectomy (CEA) that is more effective in preventing stroke compared to other therapies. The purpose of this study was to evaluate morbidity and mortality rate in patients with carotid stenosis after CEA.

In this descriptive study, 138 patients undergoing CEA admitted in the Shahid Rajaei and Velayat Hospitals in Qazvin were studied. Sex, age, and percentage of stenosis, the cause of surgery and postoperative complications during and after surgery and mortality rates were recorded. Data was analyzed using SPSS 16.

Death occurred in three cases of which two were due to loss of consciousness and one was induced as a result of cardiac arrest. These cases also had severe carotid artery stenosis and myocardial infarction. Complication rate was 27.5% (38 subjects) of whom 34 individuals had severe stenosis and four suffered from moderate stenosis. Moreover, 72% of the complications were associated with cerebrovascular attack (CVA).

Results showed acceptable rate of mortality and morbidity is after endarterectomy surgery compared to other studies.

The prediction of death in intensive care units is done by using scoring systems assess the disease severity. This study was performed to compare two scoring systems, Acute Physiology and Chronic Health Evaluation (APACHE) IV and Simplified Acute Physiology (SAPA) III, in predicting mortality rate in intensive care units (ICU).

In this retrospective cross-sectional study, we calculated 60 patient during the year 2012 admitted to ICU wards in Shahid Rajaei hospital, Qazvin, Iran. APACHE IV and SAPA III scores and predicted mortality were calculated. Then, the real mortality in intensive care units were recorded. Using the area under the curve of receiver operating characteristic (ROC), performance and differentiation of these models to predict mortality were assessed. Data were analyzed using Mann-Whitney test at the significant level of P-value of less than 0.05.

Of 74 patients admitted to the intensive care unit, 60 were included in the study, 38 men and 22 women. The mean age of patients was 59.0 years and the average duration of hospital staying was 12.10 days; 11 patients died. The mean scores of APACHE IV and SAPA III were 30.0 ± 3.4 and 15.0 ± 2.0, respectively. The area under ROC curve was 0.990 for APACHE IV with confidence interval of 0.930 to 1.008 and 0.97 for SAPA III with confidence interval 0.97-1.008with a significant difference (P < 0.001).

Our study revealed that APACHE IV scoring method predicted the mortality rates in intensive care units better than SAPSIII method.

Background and

Intravenous regional anesthesia (IVRA) is a simple and reliable method for upper extremity injuries. Different additives have been combined with local anesthetics to improve block quality، decrease tourniquet pain and postoperative analgesia in IVRA. This study was performed to evaluate the effect of (NTG) in quality improvement when added to lidocaine in IVRA.

In a clinical trial، 40 patients ASA (American Society of Anesthesiologists) I-II، the candidates with upper extremity injury were scheduled for IVRA randomly allocated into two groups. Under identical condition، the control group received 3mg/kg mg lidocaine %0. 5 and the study group received 3mg/kg mg lidocaine %0. 5 plus 200µg nitroglycerine. Hemodynamic variables were measured and recorded at 5، 10، 15، 20، and 30 min after anesthetic solution administration. The onset and recovery times of sensory and motor block were measured and recorded and tourniquet pain based on visual analog scale (VAS) score in all patients. After the tourniquet deflation، at 30 min and 2، 4، 6 and 12 h، hemodynamic variables، VAS score، total analgesic consumption in the first 24 h after operation، and the side effects were noted.

Sensory block onset time was less in NW in comparison with the control group (2. 45±0. 51042 vs 4. 35±1. 26803) Sensory and motor recovery times were prolonged in NW group compared to the control group (8. 25±2. 1734 vs 3. 825±0. 99041 min) for sensory، (4. 2000±1. 15166 vs 3. 025±0. 80255 min) for motor recovery with statistical significance (P<0. 05). The onset time tourniquet pain was prolonged in NW in comparison with the control group (22. 5±3. 12039 vs 19. 4±2. 77963 min). Pulse rate at 0. 5، 2 and 4 hr postoperatively was lower in the study group (P<0. 05). Postoperative analgesia after 0. 5h of tourniquet deflation was prolonged with statistically significant difference in VAS scores (1. 1±0. 30 vs 1. 05±0. 22).

Totally، according to the obtained results، it may be concluded that the use of nitroglycerine added to lidocaine would result in an increase in the effect of anesthetic without additional adverse effects.