فصلنامه آنستزیولوژی و مراقبتهای ویژه ایران
سال سی و هفتم شماره 2 (پیاپی 90، تابستان 1394)

Organ donation is a very difficult decision for families. Families of brain death patients are facing difficult and damaging stages of experiencing and understanding the brain death, and at the same time they also encounter the crisis of decision about organ donation. Quantitative methods and questionnaires have been used for identification of psychological problems in most studies, but perception of people’s mentality and experiences with common quantitative approach is not possible. Thus we decided to combine both quantitative and qualitative methods for deeper understanding of the psychological problems of donor’s family, to help them in making this difficult decision.
This study was performed by combining investigations. Quantitative data and donor’s family view were evaluated through questionnaire and interviews, respectively.
Qualitative results were classified in three general concepts: unknowns-fear, doubt-dependency, and excellence. Each of these concepts was divided into smaller profile. Knowledge, concerns, unknowns, dealing with family and the therapist relationship were in the subgroup of unknowns; fear of regret, the chances of recovery, rejection of others', beliefs, and obsessive thoughts were in the subgroup of doubt and fear; and acceptance of reality, altruism, religious beliefs, growing up in difficult circumstances, interests and expectations, and emotional relationships were in the subgroup of development and dependence. In the quantitative results members of the families of 224 brain death patients were evaluated. The mean age of the participants in this study was 37/13 ± 60/35 years. The mean age of patients was 51/21 ± 82/44 years. Among all the demographic characteristics of individuals only the level of education was associated with psychological disorders (P> 0.05). Children’s anxiety was also significantly higher than the other family members’ (P Quantitative and qualitative results of the psychological problems of families of brain-dead organ donors showed that because of different experiences of families, lack of awareness, harmful levels of anxiety and depression, it is necessary to appropriately support families in this crisis situations. All of them are in need of medical team sympathy and in this way we must help them to find an awareness of their unknowns, thus better understanding of these conditions is provided. By strengthening the humanitarian morale of the people, the incidence of inappropriate thoughts and confounding factors in the adoption of this crisis would reduce.

Needle stick the body, including the problems faced by those working in the operating room with the greatest likelihood of HIV and hepatitis C and B blood-borne, the staff there so The aim of this study was to determine the frequency and causes of injuries from sharp instruments contaminated by blood in the operating room staff at public hospitals in Ahwaz.
This study is a crosssectional study on Imam Khomeini, Razi, Golestan and Taleghani hospital operating room personnel was performed in 400 subjects. For data collection questionnaire was used. Analyze data using mean and standard deviation and Chi square test, the software was 19spss.
Of the 385 patients studied, 92 subject (23.9%) did not have a history of needle stick, but 293 subject (76.10%) were needle stick 1 to more than 5 times. From the employee's perspective, the factors affecting the rush needle stick (61.5%), careless partner (39.0%) and the bustle% (35.6%) are. The device that creates a needle stick the order of needle stitched (51.4%), needle syringe (37.4%), scalpel (30.6%), respectively. Chi-square test showed a significant correlation between gender, mental illness, tremors, vision problems, history, number of shifts per month, number of hours worked per week, educational level, occupation, and other activities at a health center to show the number of needle stick the (P The results showed that more than half of the operating room staff is faced with a needle stick. Considering the complications and the risk of bloodborne diseases and high rate of injuries in the operating room, looks development and training classes to prevent these problems, the need to... .

One of the major complications of percutaneous nephrolithotomy(PCLN)operation is the risk of fluid absorption and serum electrolyte changes. The aim of this study was to determine the effects of distilled water on the patient's electrolyte and hemodynamics during PCLN .
This study was an interventional clinical trial performed on 90 patients before and after PCNL. In order to collect data on electrolyte levels, blood samples were taken on admission, before irrigation, every hour during irrigation, immediately and 24 hours after the procedure, and the data were recorded.
There was a significant relationship between the irrigation fluid volume and serum sodium and potassium levels after the start of the procedure, one hour later and during recovery; however there was a significant correlation between irrigation time and sodium level but it was not the same with potassium.There was a significant correlation between irrigationfluid volume and time and heart rate before, at 10 minutes after the irrigation and also between irrigation fluid and time and duration of anesthesia before, at 10 and 30 minutes after the irrigation. There was also a significant correlation between irrigation fluid volume and duration of anesthesia immediately before, and at 20, 30, 40 minutes after; as well as between irrigation time and systolic blood pressure 10 minutes after the irrigation . However ,irrigation fluid volume and time were significantly correlated with diastolic blood pressure at 30 and 40 minutes after the procedure and there was a significant correlation between the duration of anesthesia and diastolic blood pressure immediately before the procedure.
According to the present study, hyponatremia and hypokalemia can be avoided by reducing the irrigation fluid volume and time; the serum level of sodium and potassium must be checked immediately before the irrigation and during recovery.

Traumatic brain injury makes singnificant change in the level of consciousness (LOC). Such patients, due to different reason, are at risk of sensory deprivation. It is difficult to assess the LOC of patients in ICU. The first scale to do such a thing is GCS which is of low validity because of verbal component. The FOUR has more information than GCS and seems to be better in intubated patients. The aim of the study was to determine effect of sensory stimulation program on LOC, with the a camparison of FOUR and GCS scales.
Material and This study is a clinical trial on 60 patients who had brain injury in ICU. The intervention aregular sensory stimulation by the reasarcher which is done on 6 day and 5 times a day and LOC were measured before and after intervention using both FOUR and GCS. The data analyses was done by SPSS 16.0 and using parametric and nonparametric tests and descriptive statistics method.
Results showed that the mean of FOUR was significantly different before and after intervention but this finding was not observed with the GCS scales showed a rise during 6 days of intervention and this increase was significantly higher compared to the control group.
Sensory stimulation program in patients with traumatic brain injury has positive effects. Also the FOUR provided clearer information of LOC changes for patients and was more reliable.

Central vein catheterization is a standard clinical method for central venous pressure monitoring besides being used for other therapeutic purposes. The present guidelines recommend to place the catheter tip in the superior vena cava above the pericardial cephalic reflection. The aim of this study was to compare the accuracy of two different approaches in locating the tip of the CVC at the suggested vascular zone.
Material and This was an interventional study on 100 patients undergoing CABG operation who required a central venous cannulation. They were randomly assigned into two groups. In the first group catheter placement was applied through using the conventional 15 cm method. In the second group a Clength method was applied for measuring the depth of catheter tip insertion from the preoperative chest radiographs. For statistical analysis Chi-square test and T-test were used (SPSS v.22 software).
In the first group (15 cm)100% of the patients had their catheters placed below the C-line (Carina line) and the average distance between the catheter tip and the C-line was 4.22±2.10 cm. In the second (CLength) group 52% of the catheters were below C-line with an average distance of 0.77±0.5 cm. There was a meaningful difference between the two groups in respect to the catheter location depth and zone placement. (P=0.00).
The C-Length approach in comparison to the conventional 15 cm approach resulted in a considerable higher number of catheters above the recommended C-line, thus it can provide a more reliable and safe mode for CVC placement in the SVC.

Cardiovascular stability after induction of general anesthesia is the major advantage of Etomidate. The incidence of pain on injection is a side effect of using Etomidate.The purpose of this study is to compare the efficacy of Lidocaine versus Magnesium sulfate on pain associated with intravenous administration of Etomidate .
In this clinical trial study, 99 patients undergoing elective surgery aged 18-60 years were divided into 3 groups: group 1 (control) without medication, group 2 received 30 mg of lidocaine 1% and group 3 received 2.48 mMol of magnesium sulfate. After 3 minutes, 0.2mg/kg etomidate was injected. The severity of injection pain was immediately evaluated and recorded using the scale of Ambesh et al. Data were analyzed using ANOVA, Tukey and Kruskal-Wallis tests by SPSS software version 9.0.
The incidence of pain in group I (control), regardless of the intensity of pain, was 66/67%; in group II (lidocaine) 63/60% and in group III (magnesium sulfate) 45/45%, respectively. Pain in group II (receiving lidocaine) was lower than in group I (control) (p=0.030) and also lower in Group III (receiving magnesium sulfate) as compared to group I (control) (p=0.015). In terms of pain at the injection site after receiving lidocaine and magnesium sulfate, no significant differences were observed between groups II and III (p=0.325).
Patients receiving lidocaine and magnesium sulfate had less pain on injection with etomidate compared to the control group. But the pain in the magnesium sulfate group was lower in the lidocaine group.

Postoperative pain is an acute pain, and treatment is reduce morbidity. Cataract is the most common cause of blindness in developed countries and the only effective treatment is surgery. Because the eye is a sensitive organ and most patients are elderly and with low pain threshold, therefore, it is important to reduce the pain caused by cataract surgery.
The study included 48 male and female patients with an age range of 20 to 80 years and ASA1 & 2. Patients were divided randomly to two groups of 24 person, each of the 2 groups were under general anesthesia with equal drugs, in the study group 0/1 cc lidocaine1% intra cameral was injected after anesthesia and the control groups did not receive it. Patients were assessed before surgery and recovery (time zero), 1, 2 and 3 hours after surgery in terms of pain, blood pressure, heart rate and effects such as itching.
The study group had lower pain than the control group, but blood pressure and heart rate were not significantly different between the 2 groups.
The injection into the anterior chamber is effective in reducing pain after cataract surgery.

Shivering is an early postoperative complication following neurosurgical procedures. Incidence of postoperative shivering (POS) following non-craniotomy surgeries varies between 20 to 60%. POS after craniotomy is considered high risk and requires preventive therapies. However, incidence of postoperative shivering following craniotomies is not reported in previous reports.
Aim: To determine the incidence of postoperative shivering following craniotomy.
In a descriptive study, 89 patients candidate for elective craniotomy were enrolled and followed for incidence of POS. Method of anesthesia were similar in all cases. Patients were covered with 3 layers of surgical drapes. Shivering was evaluated during the postoperative period by observation of shivering movements of more than 10 seconds duration. Core (nasopharynx) and skin temperature (dorsum of middle finger) were recorded. Patients’ temperature were measured prior to anesthesia and then every 2 hours during and after surgery.
Mean age was 53.4±14.6 and duration of surgery was 5.02±2.6. Incidence of post-craniotomy shivering was 15%. Trend of decrease in core and peripheral temperature was fast reduction at the early 2 hour of anesthesia, the slow decrease and then it reached a plateau phase. Core temperature at preoperative time (37.1±0.65) was significantly higher than in postoperative (34.2±0.56) (p=0.0001). Besides, mean peripheral temperature in preoperative period (37.2±0.72) was significantly higher than in postoperative period (34.6±0.65) (p=0.0001).
Incidence of post-craniotomy shivering was 15% in our patients. Although decrease in core and peripheral temperature were significant during craniotomy, however, the incidence of post-operative shivering is lower than other surgeries.

A 27 year old woman with ASA class 1 and with 12 weaks pregnancy was scheduled for circlage of cervix. Spinal anesthesia was selected and induced with spinal needle No:25 and 100 mg (2ml) lidocaine 5% in sitting position .After 2 days , the patient sensed lumbar pain with radiation in her left foot. The pain was sever and coexisted with paresthesia and continued for 1 month and then suppressed slowly. Neurologic exam, EMG and NCV Were normal.