Tehran University Medical Journal

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Background: Sinus surgeries are usually associated with bleeding, thus can result in hemodynamic instability. This study investigated the hemodynamic changes induced by remifentanil plus isoflurane administration in comparison with propofol plus remifentanil in patients undergoing sinus surgery.
Methods: In this randomized clinical trial study, 96 patients were divided into two groups of isoflurane (1.2 MAC) plus remifentanil (44 patients, group A) and propofol (100 μg/kg/min) plus remifentanil (52 patients, group B). Twenty-two patients in group A and 23 in group B were male. The remifentanil dosage (0.1 μg/kg/min) was equal in both groups and all received 500 ml isotonic solution during the operation too.  Premedications and anesthetic inductions of both groups were similar. The variables included age, BMI, blood loss during surgery, systolic and diastolic blood pressures, pulse rate and mean arterial blood pressure.
Results: The mean age, BMI, amount of blood loss, mean systolic (30 minutes before and after the intervention) and diastolic blood pressures (60 minutes before and after the intervention), pulse rate (30 and 60 minutes before and after the intervention), mean arterial blood pressure (60 minutes before and after the intervention) were similar in both groups. The average mean arterial blood pressure, 30 minutes after the intervention (p=0.027) and the mean diastolic blood pressure, 30 minutes after the intervention (p=0.011) in the case group had statistically significant differences with the controls.
Conclusion: Based on this study, the combination of isoflurane plus remifentanil could better maintain the hemodynamic stability during sinus surgeries.

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Background: Postpartum hemorrhage is a leading cause of maternal morbidity and mortality that is preventive by appropriate estimation of blood loss and its treatment. This study was undertaken to evaluate the accuracy of visual estimation of postpartum hemorrhage by clinicians and co worker who work in the obstetrics department.

Methods: In this descriptive observational study, 199 educational/clinical personnel participated who worked in the obstetrics department of 3 training hospital in Mashhad in 2010. First characteristic of their occupation, educational and period of work experience recorded. Then scenes similar of postpartum hemorrhage were rebuilt by using of expired whole blood in five different volume (500, 1000, 1500, 2000, 2500, 3000 cc). Participants looked each scenes and estimated volume and necessary treatment and record in forms. Data were analyzed by SPSS software version 12 and fisher and student tests and relation between accurate volume of hemorrhage and estimated volume and treatment, occupation and experience of participants were determined.

Results: Accuracy visual estimation of blood loss in different volume of postpartum hemorrhage was between 14.3% to 52%. There was no significant association between the position of the participants and accuracy of their estimation and proposed treatments. There was no association between the staffs' work experience and accuracy of their estimation.

Conclusion: Visual estimation of blood loss was not accurate in the majority of participants. For prevention of maternal morbidity and mortality education is necessary that to be skilled for accurate estimation of blood loss.