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Objectives: Traditional guidelines for preoperative fasting (POF) time lead to several complications in surgery patients. However, not enough attention has been paid to the issue. This aimed of this study was to investigate the management of fasting times in Guilan academic hospitals. Materials and Methods: In this descriptive cross-sectional study, individuals from five academic referral centers enrolled the survey and questionnaires including demographic characteristics, fasting hours for liquids and solids, POF recommenders, and patient's knowledge regarding the definition of clear liquids were completed. Results: A total of 390 individuals candidate for elective surgeries enrolled in the study, the mean age of our cases were 46.61 years. The average POF time for solids and liquids was 11.43 and 9.70 hours, respectively. 95.38% of the participants did not know a correct definition of clear liquids, which was not related to their level of education (P = 0.314). A positive association was observed between age and POF times for liquids and American Society of Anesthesiologists Classification for both solids (P = 0.010) and liquids (P = 0.0001). Conclusions: It was found that the real POF time in our hospitals was significantly longer than the modern guidelines, and needs to be corrected. [ABSTRACT FROM AUTHOR]

Introduction: Foreign-body aspiration is still considered one of the most important diagnostic and therapeutic issues for physicians. Mortality rates and the prevalence of diseases caused by foreign bodies in the airway are higher in children because of the relatively narrow airway and immature protective mechanisms. The aim of this study was to study the pattern of foreign-body aspiration in the tracheobronchial tree as well as the success rate of rigid bronchoscopy in children admitted to the Amir-al-Momenin Hospital, Rasht during 2007-2014. Materials and Methods: In this cross-sectional descriptive study, the required data were collected from the medical reports of all children under the age of 14 years with suspected foreign-body aspiration who were admitted and underwent explorative rigid bronchoscopy from 2007-2014. The data recorded in the checklists were analyzed using SPSS V16. Results: Out of 103 children with suspected foreign-body aspiration, a foreign body was seen in 74 children (71.8%) during bronchoscopy. Among 74 patients with a confirmed aspiration, 73% (54) were males and 27% (20) were females (P=0.68). The average age of the subjects was 34.82±33.4 months; 66.2% were aged 1-3 years. The most common complaints (symptoms) of patients were non-productive cough (48.6%), wheezing (44.3%) and respiratory distress (18.6%). The most common physical examination findings were unilateral decreased pulmonary sound (62.3%), generalized wheezing (26.1%), and crackles (17.4%). Sixty-three patients had a suspected history of foreign-body aspiration. The most frequently aspirated foreign bodies were nuts (peanuts). In total, 52.7% of foreign bodies were lodged in the right bronchial tree. In 95.9% of cases, the foreign body was completely extracted by bronchoscope. The majority of cases were admitted more than 24 hours after the occurrence of aspiration, and pneumonia was the most common complication. Conclusion: Patient history, especially initial suspicion of aspiration, coughing, wheezing and respiratory distress, can be helpful in the diagnosis of foreign-body aspiration. [ABSTRACT FROM AUTHOR]

Introduction: Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections affecting one-third of patients with mechanical ventilation. This study aimed to synthesize available evidence regarding the effect of treatment with povidone-iodine (PI) among adult patients admitted to intensive care units (ICUs) for the prevention of VAP., Methods: An extensive search was conducted in online databases, including PubMed, Web of Science and Scopus, from the earliest records until January 1, 2023. STATA software v14 was used for statistical analysis. Publication bias was assessed via funnel plot, Begg's and Egger's tests. A P-value less than 0.1 was considered statistically significant for publication bias value., Results: Four studies were included in the meta-analysis. Three studies showed rhat PI decreased VAP compared to the placebo group, but it was not statistically significant (RR: 0.61, 95%CI: 0.25 to 1.47, Z=1.10, P=0.27, I2:71.5%). One study compared the effect of PI with chlorhexidine on the rate of VAP, the difference between which was not statistically significant (RR: 1.50, 95%CI: 0.46 to 4.87, Z=0.67, P=0.50, I2:0). Two studies demonstrated that the use of PI intervention compared to placebo decreased the average length of stay in ICU; however, it was not statistically significant (WMD: -0.35, 95%CI:-3.90 to 3.20, Z=0.19, P=0.85, I2:0). Also, three studies showed that using PI had almost no effect on mortality rate compared to placebo (RR: 1.05, 95%CI: 0.66 to 1.53, Z=0.8, P=0.27, I2:29.0%)., Conclusion: More rigorously designed randomized clinical trials and further evidence are required to make a better decision/comparison about using PI as a suitable choice for preventing VAP among adult patients admitted to the ICU., Competing Interests: The authors declare no conflict of interest.

Introduction: Despite recent progress in treatment of burn injuries, head and neck burn and its complications is still considered a challenge. This study aimed to evaluate the baseline characteristics and outcomes of patients with head and neck burn., Methods: In this retrospective cross-sectional study, the medical profiles of patients with head and neck burn referring to a burn care center during 2 years were reviewed and analyzed regarding the baseline characteristics and outcomes of participants., Results: 392 (17.97%) cases suffered from head and neck burns. The mean burn percentage of participants was 29.31 ± 24.78, and 126 (32.14%) cases required tracheal intubation. There was a direct correlation between length of hospital stay and the degree of burn (p < 0.001). The length of hospitalization for patients burned by electricity was longer than those burned by other mechanisms (p = 0.003). There was a significant correlation between degree of burn and abnormal laryngoscopy findings (p = 0.036), developing acute respiratory distress syndrome (ARDS) (p < 0.001) and pneumonia (p < 0.001), need for mechanical ventilation (p < 0.001), and mortality rate (p < 0.001)., Conclusion: Based on the findings of the present study, the prevalence of head and neck burn injuries was about 18% and 32.14% of these cases required airway management. 19 (4.85%) cases developed ARDS, 41 (10.46%) developed pneumonia, and 50 (12.76%) cases died. There was a significant correlation between degree of burn and abnormal laryngoscopy findings, developing ARDS and pneumonia, need for mechanical ventilation, and mortality rate., Competing Interests: None.

Background: Postoperative pain control (especially, after adenotonsillectomy) has a very important effect on recovery time, hospitalization duration, hemodynamic disorders, bleeding, nausea, vomiting and medical costs., Objectives: The aim of this study was to investigate and compare the effects of intravenous and rectal acetaminophen on controlling post-adenotonsillectomy pain in children, and duration of their analgesic effects., Patients and Methods: In this randomized double-blinded clinical trial, 96 children aged 4 - 10 years old with ASA physical status I or II who were candidates for adenotonsillectomy surgery in Amir-al-Momenin Hospital, Rasht, Iran were entered into the study and randomly divided into two equal groups. Anesthesia in both groups was induced injecting fentanyl-thiopental and at racurium; afterwards is of lurane was used to maintain anesthesia. After anesthesia induction, one group received intravenous and the other one, rectal acetaminophen, and were later compared based on CHIPPS criteria., Results: Data analysis indicated a significant relationship between reduction of postoperative pain and the use of intravenous or rectal acetaminophen (P = 0.0001); in group receiving IV acetaminophen, only 10.4% of patients had no pain whereas in group receiving rectal acetaminophen, this number reached 43.8%. Also, on 4 and 6 hour time intervals, pain in rectal acetaminophen receiving group was less than that in IV acetaminophen receiving group (P < 0.05). Demand for additional analgesic medication in rectal acetaminophen receiving group was less than that in IV group (P = 0.0001)., Conclusions: Post-operative pain in rectal acetaminophen group was less than that in intravenous acetaminophen group, and rectal acetaminophen group demanded their first additional analgesic medication later.