Archives of Anesthesiology and Critical Care
Volume:6 Issue: 1, Winter 2020

Postoperative complications and patient safety are of great importance to every anesthesiologist. These complications are even more important when related to the respiratory or cardiovascular system.  The present study aimed to evaluate the frequency of major and minor respiratory complications that occur after tracheal extubation in an academic-based hospital in Iran.

In this preliminary prospective survey, the incidence of immediate major and minor complications associated with tracheal extubation after elective surgery in an academic-based hospital affiliated with Tehran University of Medical Sciences with anesthesiology residents was studied.All patients undergoing intubation in the operating room of Shariati Hospital, during the elective lists from Saturdays to Wednesdays, during two months were enrolled. Emergency patients and patients who had any complication during their intubation such as difficulty in intubation or more than two tries for tracheal intubation and patients who were transferred from the operating rooms to the intensive care unit were not included in the study. Patients with BMI over 35 were also not included in the study. During tracheal extubation and up to recovery, all respiratory adverse events including coughing and bucking, Spo2˂%90, difficult mask ventilation, apnea/hypoventilation, vomiting, laryngospasm, and aspiration were recorded. The time of the day at which complications occurred was also recorded.

Three hundred and seventeen patients were randomly studied. 171 (53.9%) patients were male and 146 (46.0%) of the studied patients were female. Overall, 184 number (58.0%) of all the patients experienced either coughing or bucking on extubation. 29 (9.1%) patients experienced apnea and/or hypoventilation, out of which 8 (2.5%) of them developed laryngospasm which was more frequent in the male population.

In this preliminary survey, it was observed that 59.6% of all the patients experienced at least one of the minor or major respiratory complications of tracheal tube extubation at the end of surgery which was more frequent in women compared to men.

Nowadays, according to the large number of cesarean sections under spinal anesthesia, finding a simple and safe pre-delivery sedation technique which provides satisfaction for mothers with no over sedation and amnesia seems to be necessary. However, there is not enough evidence about the best choice of drug for this purpose. In the present study we aimed in evaluating the clinical effects of different concentrations (0.25, 0.5, 0.75mg/kg) of thiopental Na bolus for the mother’s satisfaction in cesarean section under spinal anesthesia.

Two hundred and forty term singleton pregnant women with normal ASA physical status were scheduled for an elective term cesarean delivery under spinal anesthesia and allocated into four groups. Groups I, II, III received 0.25, 0.5, 0.75mg/kg/IV of Thiopental Na respectively and group IV as the control group received 1.5cc of sterile water,1 min after spinal anesthesia. The level of consciousness with observer assessment of alertness/sedation score (OAA/S) and mother’s satisfaction was considered as primary outcomes.

The level of mothers’ satisfaction in group II was significantly higher than other groups without any over sedation (P<0.001) and no adverse effect on their verbal contact was observed and they could easily communicate. All women could remember their infants. All babies were healthy with no complications and the Apgar scores were the same in all studied groups.

Based on the results of the present study and with comparison of different concenfrations and side effects indicates pre-delivery conscious sedation with 0. 5 mg/kg/IV of Thiopental Na could be a safe and appropriate technique for sedation in cesarean sections surgery under spinal anesthesia.

Patients undergoing surgery experience significant anxiety in the preoperative period. The aim of the present study was to identify the level of preoperative anxiety among Iranian patients in surgery clinics and its predictive factors.

In this cross-sectional study, the State-Trait Anxiety Inventory questionnaire was used to assess the patients’ preoperative anxiety. Results were analysed using the Chi-square test and binary logistic regression analysis.

246 patients were randomly selected, 222 of which were finally included in our analysis. In this study, the state and trait anxiety levels were moderate and low, respectively. Both state and trait anxiety levels were significantly higher among females (p-value 0.03 and 0.009, respectively). Also, patients with higher education had higher state and trait anxiety levels (p-value 0.001 and <0.001, respectively). Patients undergoing aesthetic surgeries had significantly higher state anxiety levels compared to other surgeries (p-value 0.04). Interestingly, the history of surgery was not significantly associated with state anxiety (p-value 0.96). Logistic regression analysis revealed that age, marital status, and education were the most predictive factors for state anxiety. These factors along with the place of residence were also predictive for trait anxiety (p-value <0.05).

Since these predictive factors are not amenable to change before elective surgery, identification of patients with higher anxiety levels is essential. Further studies investigating preoperative anxiety a few days prior to surgery in the Iranian population should be warranted.

Difficult tracheal intubation is an important challenge for anesthesiologists. Many anatomical parameters are available for evaluating the ease of tracheal intubation. Cormack-Lehane (CL) grade is one that can reliably predict a difficult intubation but it is an invasive procedure and can be performed in an anesthetised patient so it is not useful during pre-anesthetic airway evaluation. Prediction of the CL grading before operation can help in better airway management during induction of anesthesia.
The aim of this study was to find a correlation between ultrasound measured distance from skin to epiglottis and from epiglottis to mid-vocal cord with Cormack-Lehane grading in patients undergoing general anesthesia for predicting difficult intubation.

In a cross-sectional study, 60 ASA class I - III patients aged 18 - 70 years who were scheduled for tracheal intubation under general anesthesia were included. Before anesthesia, an ultrasound view of the airway was obtained and the distance from skin to the epiglottis and from the epiglottis to the mid-point between the ends of vocal cords were all recorded. The ultrasound measurements were then compared with the CL grade during direct laryngoscopy under general anesthesia.

Thirty-six patients had CL grade I, twenty-one had CL grade II and three had CL grade III. It was observed that the correlation between CL grade and distance from skin to epiglottis (DSE) with cutoff value 21mm(with an accuracy of 99%, a sensitivity of 100%, and a specificity of 82% ; P=0.0001) and from epiglottis to mid vocal cord distance (EMVD) with cutoff value 13.38(with an accuracy of 99%, a sensitivity of 100%, and a specificity of 85% ; P=0.01) and the ratio of DSE/EMVD with cutoff value 1.64(with an accuracy of 95%, a sensitivity of 100%, and a specificity of 91%; P=0.004) was significant for predicting of difficult intubation in patients with BMI>25.

Our study revealed good correlation between DES/EMVC ratio and Cormack-Lehane grade, therefore sonographic measurement criteria may be helpful in airway evaluations before anesthesia for predicting difficult intubation.

Upper GI endoscopy is a diagnostic and therapeutic procedure widely used across the world. Some patients, however, experience a great deal of discomfort during the procedure, which is mainly due to activation of the gag reflex. Therefore, topical pharyngeal or general anesthesia is applied to reduce the gag reflex during endoscopy. This study aimed to compare the effect of IV lidocaine versus topical lidocaine spray in reducing the gag reflex in patients sedated with propofol.

This randomized clinical trial was conducted in Imam Khomeini Hospital in 2017. One group of patients received propofol at a dose of 0.5-1 mg/kg plus lidocaine spray and the other group received propofol at the same dose plus IV lidocaine at a dose of 1 mg/kg (maximum 100 mg). Patients in both groups also received 50 µg fentanyl. The variables of gag reflex (using the VAS), patient and physician satisfaction, length of endoscopy, vital signs, and adverse effects were compared between the two groups.

Ninety-three patients were evaluated in this study, of whom 42 (45.2%) were men and the rest were women (n=51, 54.8%). ANOVA was used to evaluate the effect of type of anesthesia on the final level of gag reflex and the results showed lack of any significant difference between the two groups (P>0.05). Patient satisfaction was higher in the IV anesthesia group (P= 0.036) and the physician satisfaction was higher in the topical anesthesia group (P= 0.027). Among vital signs, only SBP showed a modest difference between the two groups and was significantly higher in the topical anesthesia group (P=0.04). There was no significant difference in the rate of adverse effects between the two groups (P> 0.05).

Topical anesthesia using lidocaine spray is as effective and safe as IV lidocaine in decreasing the gag reflex in upper GI endoscopy in patients sedated with propofol.

Quality of Intensive care has got more attention in case of the high cost of healthcare and the potential for harm. Poor-quality care causes high cost and quality improvement initiatives in the ICU lead to an improvement in outcomes as well as a decrease in costs. One of the crucial tools that allow physicians and nurses to monitor change in a quality improvement effort is the development of an electronic database for data collection and reporting. The objective of Intensive Care Registries is to create a high-quality registry of patients through a collaboration of academic health centers performing uniform data collection with the purpose of improving the quality and accuracy of healthcare decisions and provide a data-driven clinical decision support system for critical care medicine.

This article reviews real-world data sources in healthcare and considers registry as the main tool to address health services and outcomes research questions in critical care, and briefly describes objective, inputs and outputs of intensive care registries. As it can be comprehended from library research, the combination of patient clinical care data, quality parameters, and ICU operating costs, integrated into an electronic database, provides a valuable tool for quality improvement and overall efficiency of offered care.

Using Big Data effectively within ICUs for supporting clinical decision making can lead to predict numerous diseases and help to discover new patterns in healthcare. The ability to process multiple high-speed clinical data streams from multiple centers could dramatically improve both healthcare efficiency and patient outcomes.

To gain this goal, developing reliable and standardized health analytics platforms as well as quality improvement processes that translate analytical results into new clinical guidelines, is recommended.

With regard to critical illness and stress, medication side effects, decreased appetite, and increased nausea and vomiting; patients admitted to intensive care units (ICUs) are at particular risk of malnutrition. Feeding behavior i.e. time and method in these patients has still remained as an unresolved issue. Thus; enteral and parenteral nutrition, with their own benefits and complications, are two commonly used methods for such individuals. The present systematic review was to compare the effects of enteral and parenteral nutrition in patients admitted to ICUs.

This systematic review investigated a total number of 1642 articles on nutrition methods in ICU patients during 2010-2019 using keywords of “enteral nutrition, parenteral nutrition solutions, parenteral nutrition, critical care outcomes, critical illness, intensive care unit, and ICU” in the databases of SID, Iranmedex, MEDLIB-ED, PubMed, Scopus, Medline, Embase, Cochrane, Web of Science, and Google Scholar; and finally, 15 articles were analyzed in relation to the research objectives.

Studies indicated that patient mortality was not different in enteral and parenteral nutrition groups. The incidence rate of infectious complications was also reported higher in parenteral nutrition group. However, there was no significant difference in the incidence rate of infections in studies meeting total standards for parenteral nutrition. Besides, there was no significant difference between the duration of undergoing mechanical ventilation and hospitalization time in both groups. Furthermore, the incidence rate of hypoglycemia was higher in enteral nutrition group; but serum protein levels had much better status compared with those in parenteral nutrition group.

If standards for infusion are observed and provided that rates of infectious complications are reduced, patients can benefit from starting parenteral nutrition immediately after admission to ICUs in the absence of enteral method.

Airway management becomes a challenging task in subglottic stenosis due to noncompliant stricture. Location and extent of stricture also pose difficulty in securing front of neck access.  management with use of available resources provides immediate lifesaving solution for anticipated or unanticipated life threatening conditions especially causing airway compromise.

Airway management becomes a challenging task in subglottic stenosis due to noncompliant stricture. Location and extent of stricture also pose difficulty in securing front of neck access.  management with use of available resources provides immediate lifesaving solution for anticipated or unanticipated life threatening conditions especially causing airway compromise

Video laryngoscopy has opened its way into airway management and continues to play a larger role in managing patients with difficult airway. Anesthesiologists use video laryngoscopy more often every day and therefore accept the risks of more challenging and difficult airway situations with more confidence. In the mentioned case below, a 45-year-old female with a large thyroid mass is presented to an academic based hospital, for elective thyroidectomy. The patient was intubated using a video laryngoscopy technique and the airway was secured. Video laryngoscopy helps secure difficult airways and could be chosen as first line option in such situations.