bahman hassannasab

Prolonged mechanical ventilation and the need for tracheal intubation are the main indication of tracheostomy. This procedure can be done, in two ways: surgical tracheostomy or percutaneous tracheostomy. In this study, surgical tracheostomy was compared with percutaneous method in the intensive care unit.
This clinical trial study was performed on 61 patients admitted to the intensive care unit of Ayatollah Rohani Hospital of Babol University of Medical Sciences from April 14, 2013 to April 14, 2016. In the first group (44 cases), tracheostomy was performed in percutaneous (PDT) and in the second group (17 patients) surgically. The early complications and waiting time (intubation to tracheostomy) for tracheostomy were compared in two groups. All data were analyzed by SPSS software, ver. 22 (Armonk, NY, USA), Analysis of variance (ANOVA) and P values of less than 0.05 were considered significant.
The mean age of the patients was 59.87±8.15 years. The mean age of the male patients was 59.66±6.35 years and the female patients were 60.35±6.41 years. In this study, the average waiting time (time from intubation to tracheostomy) was 14.19 days in the PDT group and 20.69 days in the tracheostomy group, with a significant difference between the two groups (P= 0.001). The incidence of preoperative bleeding after surgery was five cases (8.2%). In the PDT group, two cases (3/3%) and the surgical group was three cases (4.9%) and the two groups did not have a significant difference (P= 0.46). The incidence of wound infection (during the period of admission and up to ten days later) in two groups was two patients (3.3%), one case (1.6%) In the PDT group, and one case (1.6%) in a surgical group and the two groups did not have a significant difference (P= 0.43). Other complications such a subcutaneous emphysema and posterior tracheal wall trauma and rupture was not shown in both groups.
The findings of this study showed that the complications (bleeding and wound infections) did not differ between the two groups. Due to the lower waiting time and the lack of need for patient transfer outside of the intensive care unit, percutaneous tracheostomy can be a safe alternative to the surgical tracheostomy.

Positive effectiveness of antiemetic drugs was approved in reduction of post-operative nauseaand vomiting) PONV. The purpose of this study was comparison of Dexamethazone and Ondansetron with Dexamethazone and Metoclopramide in preventation of PONV.

In this study, was selected 80 women in ASA class I, II for elective abdominal hysterectomy under general anaesthesia and was divided in to two groups (n= 40). One group received a combination of Dexamethazone with Ondansetron and in second group was injected a combination of Dexamethasone with Metoclopramide near the end of surgery. PONV was evaluated at 2hr and 6 hr after operation. The results were analyzed, using pearson chi-square and fisher’s exact test.

Injection of two drugsOndansetron and Metoclopramide affect in reduction PONV. But, the rate of reduction of nausea and vomiting was not significant in 2 groups in 2 hr after surgery (p= 0.723). Its rate was significantly lower in Ondansetron group after 6 hr (p< 0/001).

In the patients with selective hysterectomy under general anesthesia for reduction of PONV can be apply from acombination of Dexamethasone and Ondansetron which show more effectiveness and longer duration as compared to Metoclopramide and Dexamethasone.