فصلنامه آنستزیولوژی و مراقبتهای ویژه ایران
سال چهل و سوم شماره 4 (پیاپی 112، زمستان 1399)

The use or non-use of non-invasive mechanical ventilation (NIV) is one of the most important concerns of the treatment team in acute respiratory distress caused by Covid 19 disease. Therefore, this review study was conducted to determine the use or non-use of this ventilation in respiratory distress caused by the Covid 19 pandemic. This systematic study was conducted in 2021 with the entry of 14 articles. For this purpose, the articles were reviewed by the authors with the help of article quality index. In response to 4 questions posed to the authors regarding non-invasive mechanical ventilation in Covid 19 patients, it was found that although this ventilation is widely used in Covid 19 patients, in any case, there is a need for further studies and clinical guidelines in This is especially mandatory.

Since the role of this vitamin in the complications of diseases such as deep vein thrombosis has not been properly determined and previous studies have shown the effects of deficiency of this vitamin on the prevalence of deep vein thrombosis and also considering that urological surgeries, they are the most common surgeries. We decided to perform the present study by examining the level of vitamin D in patients with a diagnosis of deep vein thrombosis after urological surgery.

This descriptive cross-sectional study was performed in Imam Reza Hospital (Tabriz, Iran) in 2011 with the participation of 51 patients after urological surgery and DVT. Serum vitamin D levels were measured for all patients and its risk factors were compared using chi-square statistics.

Serum levels of vitamin D in older ages (p = 0.015), female gender (p = 0.012), higher body mass index (p = 0.026) and diabetes mellitus (p = 0.039) as Significance is less than the normal range.

Low levels of vitamin D can be one of the predictors of deep vein thrombosis after urological surgery; However, it is necessary to pay attention to other variables along with vitamin D.

Many studies have shown the effect of dexmedetomidine in decreasimg the levels of reactive oxygen species (ROS) and increasing the endogenous antioxidants. Our goal was to determine the effect of dexmedetomidine on the serum levels of several endogenous antioxidants following spinal surgeries. Forty patients were allocated into two groups: control and intervention. Both groups underwent the same general anesthesia process except the dexmedetomidine infusion in the intervention groupversus normal saline in control group (blinding). Blood samples were drawn before induction and after surgery in recovery roomand levels of Gluthatione peroxidase, catalase and super oxide dismutase were assessed. Superoxide dismutase and catalase levels did not change significantly but glutathione peroxidase levels after the surgery was meaningfully higher than the preoperative measures in both groups. Depite observed differences in the mean of antioxidant levels between the groups, this diversity was not statistically meaningful.

Quantitative and qualitative improvements in surgeries have increased the need for transfusions, leading to double pressure for proper blood storage and increasing the likelihood of unnecessary cross-match and high cross-match to transfusion ratio (C / T Ratio). In this study, we evaluated the role of anesthesia and surgical assistants training in reducing the C / T Ratio.

Between April 2018 and April 2019, sixty-two anesthesia and surgical assistants of different specialties in Imam Khomeini Hospital Complex in Tehran were first trained on the amount of blood requested. Then we evaluated the effect of training on CT Ratio one month before training and one month after training by reviewing files and counting blood bank data. The significance is considered as p <0.05.

Twenty-one (33.9%) of 62 assistants were female. The mean C / T ratio before and after training was 3.87± 1.88 and 3.06 ±1.13, respectively which was significantly different. In control group, the mean C/T ratio before and after education was 3.59±0.91 and 3.75±0.77, respectively, that was not significantly different. In the group of female residents, the mean C / T ratio after training was significantly reduced (P = 0.03) while in the group of training male residents the mean C / T ratio before and after education did not change significantly (P: 0.44).

It seems that the supply and demand pattern of blood products in Imam Khomeini Hospital Complex as a referral center is not suitable which imposes extra costs on health system. It is recommended that transfusion request training courses and hemovigilance systems should be considered more seriously.

The aim of this study was to investigate the severity of death anxiety among nurses working in intensive care units.This descriptive-correlational study was performed on 120 nurses working in the intensive care units (ICU) of Qom hospitals in 1399. Samplings were also selected by available methods. The data collection tool in this study was a Templer questionnaire, the first part of which is demographic characteristics and the second part is the Leicester death anxiety questionnaire. SPSS-25 version was used to analyze the obtained data. The mean total score of death anxiety of nurses (7.14 ± 1.93) was 20.8% of them experienced mild death anxiety, 70.8% moderate death anxiety and 8.3% severe anxiety and the mean total score of anxiety Death was not significantly associated with demographic variables. Due to the effect of death anxiety on the physical and psychological aspects of nurses, it is necessary to install support systems in hospitals in order to improve the performance of nurses.

Acromegaly is a chronic, insidious and debilitating disease that often occurs due to excessive secretion of growth hormone by the anterior pituitary adenoma. Patients with this disorder often have multisystem involvement, including respiratory, cardiovascular, neuromuscular, neurological, and skeletal.Airway management in these patients faces anesthesiologist to a great challenge due to overgrowth of airway soft tissue (enlargement of tongue and epiglottis), skeletal changes, recurrent laryngeal nerve palsy, cricoarytenoid joint involvement and thickening of vocal cords and predispose the patient to airway obstruction. We present a case in which the patient airway administration was unexpected.

A 25-year-old man with a history of acromegaly was referred to our anesthesiology clinic for severe decrease visual acuity in right eye for vitrectomy. After taking the history and performing the necessary examinations, tests and consultations for the operation, it was decided to undergo general anesthesia and insert a laryngeal Mask Airway. Despite using different mask sizes, changing head position and standard techniques, thumb, 90-degree rotation, 180-degree, partial inflation, and laryngoscopic guide, we were unable to insert the LMA and the patient completed surgery and recovery without complications.

Complete preoperative evaluation of acromegaly patients is very important in the anesthesia and airway management. This preoperative evaluation helps the anesthesiologist to make the necessary arrangements in the patient's airway management to prevent the risks. Supraglottic devices such as laryngeal masks are useful in cases where mask ventilation and tracheal intubation are difficult. But the opposite can also happen. Therefore, our scientific evaluation and decision-making may not take place before the procedure during the procedure and we may have to use other methods. Therefore, the anesthesiologist must be prepared to implement the difficult airway management algorithm.