نشریه آنستزیولوژی و مراقبتهای ویژه ایران
سال چهل و پنجم شماره 2 (پیاپی 118، تابستان 1401)

Cesarean section surgery is one of the most common surgeries in the world. 3-5 percent of all blood transfusions are associated with obstetrics cesarean section surgery has a higher risk than vaginal delivery. Potential blood transfusion-associated risks have caused health providers to assess blood transfusion use more precisely which resulted in a decreased tendency for blood product prescription. Packed red blood cell transfusion-related during cesarean section surgeries have decreased to 1.1 to 1.6 percent in some medical centers while have remained 5.2 to 6.8 percent in some others. Blood product transfusion is life-saving per se but is associated with some complications. Complications include disturbance of body temperature control acute lung injury, delayed hemolytic reactions, none hemolytic reactions, and infectious which can cause mild or serious complications. In many centers all over the world, blood transfusions have been instructed but some researches show they are not followed.

in 2019, aimed at packed red blood cell transfusion condition we instructed a descriptive-analytic study on 303 patients who have gone cesarean section surgery in years 207-2018 at Shahid Motahari teaching hospital in Ormia University of Medical Sciences in Iran. The results of the study showed the prevalence of anemic patients (Hb <10.5 gram per deciliter) at admission for surgery was 23.4%. 46.6% of patients who received PRBC had Hb≥10 at discharge from the hospital. 41.8% of patients had Hb≥ 10 gr/dl during hospitalization.

According to our research, a significant percentage of patients had over-transfusions. Lack of in-hospital transfusion guidelines and triggers and targets for patients’ hemoglobin correction needs serious attention to be instructed as soon as possible.

Resistant Status Epilepticus (RSE) is one of the most common neurological emergencies in children. So far, there is no definitive treatment for resistant Status epilepticus refractory to benzodiazepines or other anticonvulsants. Different protocols have been introduced as the second line of treatment after benzodiazepines, which include phenytoin, sodium valproate, levotiracetam, barbiturates, and propofol. In case of failure of the first-line (benzodiazepines) or second-line (other anticonvulsants) ketamine with a bolus dose of 1 mg/kg and then an infusion of 2 mg/kg/h up to a maximum of 7 mg/kg/h along with other drugs is recommended. Ketamine is a non-competitive N-Methyl- D-Aspartate (NMDA) receptor antagonist, which controls seizures with neuron-protective effects and anti-inflammatory and anti-epileptic properties in the second and third lines. We reviewed the literature to demonstrate the potential role of ketamin as an advanced second and thirdline agent in the treatment of RSE and we concluded that the best way to treat resistant status epilepticus is to start treatment on time, use multiple drugs instead of one drug, and choose drugs with neuron protective effects with the least side effects. Therefore, using ketamine with other drugs seems to be effective for seizure control.

Cardiopulmonary resuscitation is an emergency operation in cases of cardiorespiratory arrest, and the speed of operation is the most important predictor of its success. Recording recovery operation information is an important step to find faults in the system, monitor recovery operations, and optimize its processes. Like any information recording mechanism, incomplete data recording is the most important obstacle for such a system to reach its goals. Therefore, in this study, a comparison of paper and electronic recovery operation reports has been made .

This study was conducted in Imam Khomeini hospital complex in Tehran. In 2018, nurses were asked to register resuscitation registration forms instead of traditional paper forms in the electronic forms available in the hospital's electronic file system. In the design of these forms, an effort was made to maintain the structure of the Ustein standard form, to select as many fields as possible and to minimize typing. At the end of the year, 150 cases of paper recovery operation report forms that were registered in 2018 were randomly selected and compared with 150 cases of electronic forms registered in 2019.

The number of 150 paper reports and 150 electronic reports on demographic status, advanced resuscitation, and the result and information of people involved in resuscitation were compared. The average completion of demographic information in paper form was 82.3%, in the case of advanced resuscitation in paper form 76.6%, and the result and people present in resuscitation was on average 80%. While all the cases in the electronic form were completely completed except for underlying disease with 46% and rhythm change during resuscitation with 40% of information completion.

Registering the resuscitation operation report is the first step in identifying the weaknesses and optimizing the resuscitation operation in the hospital. The present study shows that changing the registration form of reclamation report from paper to electronic can improve the registration of all items related to reclamation operations.

Patient safety is one of the most important concerns of the entire care system. Since patient falls have always been one of the most important safety challenges in the care system and are considered to be the cause of more than 90% of unwanted incidents reported during hospitalization. In this regard, the present study was conducted with the aim of investigating factors affecting falls in the operating room and providing a solution to reduce the occurrence of patient falls.

The present study was conducted using a systematic review method (metasynthesis). The search was performed using the keywords patient falls, patient safety, and falls in the operating room from the databases PUBMED, Science Direct, Ovid, Pro Quest, and articles related to patient falls in the operating room published before 2019 were included in the study. and was analyzed. Data analysis was done using thematic analysis method.

Fall risk factors include three categories of patient, environment and staff factors. Patient factors include age, obesity, impaired consciousness, restlessness and specific position, and use of specific medications. Environmental factors such as uneven surface and uneven paths, bed or broken stretcher. The factors of employees are team work, sense of responsibility and work conscience .

Preventing falls in the operating room during the entire time the patient is in the operating room and during surgery is one of the patient safety priorities, and the cooperation and teamwork of all operating room staff is the most important fall prevention strategy.

Stroke is one of the main causes of death and disability worldwide, and its timely diagnosis even in pre-hospital situation and by emergency medical technicians, can speed up the treatment onset, reduce the complications of the disease and will be effective in reducing the burden of stroke in society. For initial diagnosis, the FAST criteria is used. The aim of this study is to evaluate the accuracy of diagnosing acute stroke using FAST criteria performed by emergency medical technicians, in patients transferred to the emergency department.

The present study is a cross-sectional study, perfumed on 188 patients with acute stroke transferred to the emergency room of Shahid Beheshti Hospital (Qom, Iran) in 2018. Accuracy of diagnosis by emergency medical technicians using FAST criteria and its compliance rate with neurologist’s diagnosis was evaluated. Significance level was considered 0.05.

compliance rate of diagnosis of emergency medical technicians using FAST criteria and the neurologist's diagnosis was 76.1%. The sensitivity, specificity and diagnostic accuracy of FACE pronounced by the technician were 96.6, 57.2 and 60%, respectively. The sensitivity, specificity and diagnostic accuracy of the ARM pronounced by the expert were 97%, 27.3% and 73%, respectively. The sensitivity, specificity and diagnostic accuracy of SPEECH pronounced by the expert were 97.4%, 58% and 70%, respectively.

The accuracy of stroke diagnosis by emergency medical technicians using FAST criteria is relatively appropriate and the use of this method can improve the process of diagnosis and treatment onset in these patients.

This case report presents the successful placement of a subclavian vein catheter through a subclavian approach under ultrasound guidance in a patient with a displaced, dilated colon in the neck .

The patient had a history of achalasia and had undergone several surgeries, which required a central vein due to the presence of several indications. Because of the dilated colon, access to the anterior neck space was not possible, making cannulation of the internal jugular vein unsafe. The subclavian vein was chosen for catheterization because of its lower risk of infection and thrombosis and its ability to remain safely in place for long periods of time.

Ultrasound-guided central venous cannulation has become a gold standard because it can reduce the risk of complications associated with blind cannulation. There are different methods for ultrasound-guided subclavian vein catheterization, including supraclavicular versus subclavicular visualization and long-axis versus short-axis vein visualization, and in-plane versus out-of-plane needle placement. Additional techniques and equipment are also available, such as hydrolocation and microconvex array pediatric probes, which have been introduced in various studies .

In conclusion, it should be noted that mastery and optimal visualization of vessels is important when using ultrasound guidance for subclavian vein catheterization. We suggest that ultrasound-guided subclavian vein catheterization via a subclavian approach offers a safe and effective alternative for patients with similar clinical presentations .